Abstract
Objectives: Experience of hypnosis in gastrointestinal (GI) endoscopy is scarce in children. Our aims were to assess the rate of successful GI endoscopy performed using hypnosis alone or in combination with midazolam, with or without additional equimolar mixture of oxygen and nitrous oxide (EMONO), and to identify predictive factors of successful endoscopy in children.Methods: This prospective single-centre study included children older than 6 years requiring a diagnostic esophagogastroduodenoscopy (EGD) or rectosigmoidoscopy. Ericksonian hypnosis was performed alone or in combination with midazolam, with or without additional EMONO. Successful endoscopy was defined by a complete and well-tolerated procedure. Levels of satisfaction of the endoscopist, nurse, and patient were assessed.Results: One hundred forty children [70 boys, median age: 12 years (Q1–Q3: 9–14)] were included over a 14-month period. They underwent EGD in 51.4% (n = 72) and rectosigmoidoscopy in 48.6% (n = 68) of cases. EMONO and midazolam were combined with hypnosis in 136 cases (97.1%). Successful endoscopy rate reached 82.9%. The procedure was interrupted due to poor tolerance and was rescheduled under general anaesthesia in 11 patients (7.9%). Predictive factors for successful endoscopy were older age (13 vs. 8 years, OR: 1.34, CI 95% [1.10–1.62], p = 0.003) and type of endoscopy (EGD vs. rectosigmoidoscopy, OR: 16.34 [2.14–124.68], p = 0.007). A good cooperation of the patient was reported by the endoscopist and the nurse in 88.4 and 86.9% of cases, respectively. Ninety-two per cent of patients mentioned that the procedure went well.Conclusions: Our study suggests that hypnosis combined with EMONO and/or midazolam is of additional value to perform diagnostic EGD or rectosigmoidoscopy in children older than 6 years without systematic need for general anaesthesia.
Highlights
Pain triggered by gastrointestinal (GI) endoscopy is, such as any pain, multidimensional and encompasses sensorial and emotional fields
In 2009, another randomised controlled trial (RCT) showed the benefits of hypnosis combined with a local anaesthetic (EMLA R ) compared with distraction combined with the same anaesthetic on venepuncture-induced pain in 45 children affected with cancer [6]
One hundred eighty-four patients older than 6 years requiring a diagnostic EGD and rectosigmoidoscopy were considered for inclusion, which corresponded to 29.6% of the 621 patients who underwent GI endoscopy during the study period
Summary
Pain triggered by gastrointestinal (GI) endoscopy is, such as any pain, multidimensional and encompasses sensorial and emotional fields. Anxiety is an emotion close to painful experience, as it can increase the perception of pain This situation commonly observed among children has been seen in adult studies where scores of anxiety and pain often have a positive correlation [1, 2]. In 2009, another RCT showed the benefits of hypnosis combined with a local anaesthetic (EMLA R ) compared with distraction combined with the same anaesthetic on venepuncture-induced pain in 45 children affected with cancer [6]. Patients from the former group displayed less anticipatory anxiety and less behavioural distress during the intervention. No paediatric study reported the use of hypnosis during GI endoscopy
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