| Summary: | 碩士 === 高雄醫學大學 === 醫務管理學研究所碩士在職專班 === 98 === Aims:
1. To explore the difference of patient’s tolerance and satisfaction of unsedated
diagnostic esophagogastroscopy(UD-EGD) between patient’s characteristics.
2. To explore the difference of patient’s acceptance, tolerance and satisfaction of
UD-EGD between different scope size and scoping route ( transnasal or
Peroral? )
3. To determine the effect of these factors on the outcomes of acceptance,
tolerance and satisfaction.
4. To explore the difference of scoping time between transnal EGD and peroal
EGD . And to determine whether peroral ultra-thin EGD is superior to
transnasal ultra-thin EGD？
Materials and methods
328 OPD patients were enrolled and were allocated randomly to three groups to
undergo EGD with different scope size and scoping route —110 patients for 5mm
transnasal(TN) , 109 patients for 5mm-peroral(PO), and 109 patients for 9mm
standard EGD(ST). This study was proved by IRB of Ping-Tung Christian Hospital
and all the patient’s age, sex, marriage, income , education , BMI , experience of
EGD , history of GI disease , family GI disease history, chronic disease history, the
knowledge of EGD, anxiety before EGD were collected before procedure . During
the procedure, the heart rate and PaO2 , the frequence of gagging and choking, and
the procedure time were recorded by the nurse . After completing the EGD
procedure, patients were asked to answer the validated questionnaires which included
three outcomes—acceptability, tolerance and satisfaction. Acceptabilty was defined as
the willing to choose the same procedure in the future. Tolerance was defined as
discomfort which is measured by validated VAS scale 0-10 ( 0 means no discomfort,
10 means untolerable discomfort) during topical anesthesia, intubation, examination,
extubation and overall. Satisfaction questionnaire, modified from Robbin PPS,was
designed regarding to the EGD procedure, dorctor’s skill, waiting time and procedure
time, physician’s explaining , and nurse’s attitude .
X
Result
Five patients withdrawed form the TN group and 105 underwent the transnasal
EGD. There were 6 failures of nasal intubation due to anatomic problem and 99
patients completed the procedure. Two of the 99 patients developed nasal bleeding.
Six patients and five patients withdrawed from the PO group and ST group repectively.
All of the remainders of PO group and ST group complete EGD successfully without
adverse event. Statically significant factors for satisfaction are old age, low
discomfort VAS scores, married, high income, small scope size and positive belief .
Significant factors for tolerance are old age, small scope size, male gender and
married. Scope size rather than scoping route is the determining factor for
acceptability , tolerance and satisfaction. The procedure time of transnasal EGD is
longer than that of peroral EGD. Compared to ultra-thin 5 mm peroral EGD, the
trans-nasal route need longer time 19.9 minutes vs 16.8 minutes, induced less gagging
reflux 1.7 vs 2.8 times , sense more pain during intubation 2.8 vs 1.56 VAS scores, the
insignificant different willing to do the same procedure in the future is 87.9% vs
94.2%. There is no significant difference of procedure discomfort and satisfaction
between the transnasal route and peroral route ( 13.2 vs 13.1 VAS scales, and 49.2 vs
49.1 score ).
Conclusion
1. The significant factor of satisfaction is small scope size, knowledge of EGD and
income. The significant factor of procedure discomfort is old age , small scope
size and male gender.
2. Small scope size rather than scoping route is the determining factor of
acceptability, discomfort and satisfaction.
3. The procedure time of trans-nasal EGD is longer than per-oral EGD
4. Peroral ultra-thin EGD is superior to transnasal ultra-thin EGD owing to good
acceptability , low discomfort, high satisfaction , high successful rate and no
bleeding complication.
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