Office-based ultrathin esophagogastroduodenoscopy in a primary care setting

Abstract

Background: Upper gastrointestinal complaints are common in primary care. These patients are often referred for evaluation with the use of esophagogastroduodenoscopy. This study examines the feasibility and safety of office-based ultrathin (diameter, 5.9 mm) esophagogastroduodenoscopy (u-EGD) without conscious sedation in a primary care setting. Methods: This study is a retrospective chart review in a university-based family medicine residency in the southeastern United States. Charts were reviewed for adult outpatients (N = 126) who were referred for further evaluation of heartburn, dyspepsia, or epigastric pain and who elected to undergo u-EGD procedure. We examined the number of patients willing to undergo office-based u-EGD, patient demographics, procedure indications and findings, patient request for oral benzodiazepines, and procedure and recovery times. Results: Of the 132 patients asked to participate in office-based u-EGD, 126 (95.4%) were willing to undergo this procedure (mean age, 47.6 ± 1.3; 75% women). Of 126 patients, 122 (96.8%) tolerated office-based u-EGD, and 80.6% of patients requested oral anxiolytic medications. Significantly more women than men requested oral anxiolytic medications (84.0% versus 65.6%, respectively; P = .026). The retroflexion maneuver was completed in 120 of 122 (98.4%) patients, and the second portion of duodenum was reached in 122 of 122 (100%) patients. Mean procedure time was 16.9 ± 0.7 minutes, and mean recovery time was 3.8 ± 0.2 minutes. There were no complications reported in this case series. Conclusions: The majority of patients can tolerate office-based u-EGD without conscious sedation in a primary care setting, but most patients request oral anxiolytic medications. Statistically more women request oral anxiolytic medications than do men.