3718 SMALL CALIBER ESOPHAGOGASTRODUODENOSCOPY WITHOUT SEDATION: LESS EXPENSIVE AND LESS TIME CONSUMING THAN CONVENTIONAL ENDOSCOPY.

Abstract

Background: A significant portion of the costs and complications of esophagogastroduodenoscopy (EGD) are related to the use of sedation. Small caliber EGD (scEGD) without sedation has been proposed as an alternative. The feasibility and tolerability of scEGD has been evaluated; however, there is limited data concerning time and costs associated with this procedure. Aim: To prospectively compare time and costs associated with scEGD without sedation to conventional endoscopy (cEGD) with sedation. Patient tolerability, preference, and technical feasibility were also assessed. Methods: Sixteen patients were recruited and underwent scEGD using the Pentax EG-1840 (outside diameter 6 mm, biopsy channel 2 mm) without sedation (20% topical benzocaine spray). One investigator (ABG) performed all procedures. Immediately after the procedure patients completed a survey using visual-analogue scale to assess degree of choking, discomfort, sore throat, overall tolerability, willingness to repeat the procedure without sedation, and preference regarding sedation for future procedures.A control group of 16 patients was chosen matched for age, sex, day and indication of procedure. The time of procedure (scope in to scope out), time in procedure room, time in recovery room, and procedure costs were determined in both the study and control groups. Costs were obtained from the TSI accounting system at our institution. When costs were not available standardized cost to charge ratios were applied. Statistical analysis was performed using t-tests for continuous variables and chi square for dichotomous variables. Results: Procedure time, total time in room and recovery room time were 5.2, 16.3, and 9 min for scEGD and 13.5, 34.9, and 41.3 min for cEGD, respectively (p<0.001 for all comparisons). The mean cost of scEGD, excluding physician fees, was $277 which was significantly lower than the $347 for cEGD (p=0.002). Survey results revealed excellent tolerance for the unsedated procedure and all but one patient preferred unsedated scEGD to sedated cEGD for future procedures. Conclusions: Unsedated small caliber EGD results in a shorter time of procedure, less time spent in procedure room, reduced recovery room time and lower costs as compared to conventional EGD with sedation.We confirmed the technical feasibility of this procedure and found that unsedated EGD using the small caliber scope is well tolerated.