A pilot project in office-based diagnostic esophagogastroduodenoscopy comparing two nonintravenous methods of sedation and anesthesia

Abstract

To evaluate the performance and findings of diagnostic esophagogastroduodenoscopy (EGD) procedures in a primary care office setting, comparing two nonintravenous methods of sedation and anesthesia. A consecutive case series of patients with appropriate indications referred over a 13-month period for the EGD procedure was studied. Procedure outcomes and patient acceptance were evaluated following the procedure. Patients were referred from community primary care physician offices to another community private office. Medically stable adult patients with indications for nonemergent EGD were referred for evaluation. Esophagogastroduodenoscopy was performed in an office setting using small-caliber (7.9-mm or 9.0-mm) fiberoptic endoscopes. Patients were given either diazepam orally and ketorolac tromethamine intramuscularly or triazolam orally and butorphanol tartrate spray intranasally as sedation prior to the procedure. Clinical findings observed, histopathologic results, complications, oxygen desaturation, cardiac dysrhythmias, and length of procedures were recorded. Patients reported pain and satisfaction scores on a linear numeric scale following the procedure. No major complications were noted in this study population. Seventy-three percent (52/71) of all patients rated their discomfort during the office-based EGD procedure as mild, with 49% (35/71) giving the lowest possible pain score rating. Ninety-six percent (68/71) of all patients rated their satisfaction with the procedure as high, with 65% (46/71) reporting the highest possible level of satisfaction. The study did not demonstrate a significant difference in patient comfort or satisfaction between the two methods of nonintravenous sedation. Two alternative methods to intravenous sedation and anesthesia appear to create adequate comfort and satisfaction for patients undergoing EGD and merit future study and consideration.