The study on patient’s acceptance, tolerance andsatisfaction of unsedated diagnostic esophagogastroscopy

• Main Authors: Lian-Feng Lin, 林連豐
• Other Authors: Ke-Zong MA
• Format: Others
• Language: zh-TW
• Published: 2010
• Online Access: http://ndltd.ncl.edu.tw/handle/30244181939735420467

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.