Causative factors of discomfort in esophagogastroduodenoscopy: A large-scale cross-sectional study

BACKGROUND: It is important to reduce patient discomfort in esophagogastroduodenoscopy. Remedial measures can be taken to alleviate discomfort if the causative factors are determined; however, all the factors have not been elucidated yet. AIM: To clearly determine the factors influencing discomfort in transoral esophagogastroduodenoscopy using a large-size cross-sectional study with readily available data. METHODS: Consecutive patients who underwent screening transoral esophagogastroduodenoscopy consecutively between August 2017 and October 2017 at a health check-up center were included. Discomfort was evaluated using a face scale between 0 and 10 with a 6-level questionnaire. Univariate and multiple regression analyses were performed to investigate the factors related to the discomfort in esophagogastroduodenoscopy. Univariate analysis was performed in both the unsedated and sedated study groups. Age, sex, height, body mass index, smoking status, alcohol intake, hiatal hernia, history of gastrectomy, biopsy during examination, Lugol’s solution usage, administration of butylscopolamine with/without a sedative (pethidine, midazolam, or both), endoscope model, history of endoscopy, and endoscopists were considered as possible factors of discomfort. RESULTS: Finally, 1715 patients were enrolled in this study. Overall, the median discomfort score was 2 and the interquartile range was 2-4. High discomfort (score ≥ 6) was recorded in 18% of the participants. According to univariate analysis, in the unsedated group, young age (P < 0.001), female sex (P < 0.001), and no history of endoscopy (P < 0.001) were factors associated with increased discomfort. Significant differences were also noted for height (P = 0.007), smoking status (P = 0.003), and endoscopists (P < 0.001). In the sedation group, young age (P < 0.001), female sex (P < 0.001), and no history of endoscopy (P = 0.004) were associated with increased discomfort; additionally, significant differences were found in smoking status (P < 0.001), type of sedation (P < 0.001), and endoscopists (P = 0.027). There was also a marginal difference due to alcohol intake (P = 0.055). Based on multiple regression analysis, young age, female sex, less height, current smoking status, and presence of hiatal hernia [regression coefficients of 0.08, P < 0.001 (for -1 years); 0.45, P = 0.013; 0.02, P = 0.024 (for -1 cm); 0.35, P = 0.036; and 0.34, P = 0.003, respectively] were factors that significantly increased discomfort in esophagogastroduodenoscopy. Alternatively, sedation significantly reduced discomfort and pethidine (regression coefficient: -1.47, P < 0.001) and midazolam (regression coefficient: -1.63, P = 0.001) significantly reduced the discomfort both individually and in combination (regression coefficient: -2.92, P < 0.001). A difference in the endoscopist performing the procedure was also associated with discomfort. CONCLUSION: Young age, female sex, and smoking are associated with esophagogastroduodenoscopy discomfort. Additionally, heavy alcohol consumption diminished the effects of sedation. These factors are easily obtained and are thus useful.