Saudi Journal of Gastroenterology
Home About us Instructions Submission Subscribe Advertise Contact Login    Print this page  Email this page Small font sizeDefault font sizeIncrease font size 
Users Online: 476 

EDITORIAL Table of Contents   
Year : 2010  |  Volume : 16  |  Issue : 4  |  Page : 243-244
Unsedated endoscopy: Is it feasible?

Gastroenterology Division, Internal Medicine Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia

Click here for correspondence address and email

Date of Web Publication24-Sep-2010

How to cite this article:
Aljebreen AM. Unsedated endoscopy: Is it feasible?. Saudi J Gastroenterol 2010;16:243-4

How to cite this URL:
Aljebreen AM. Unsedated endoscopy: Is it feasible?. Saudi J Gastroenterol [serial online] 2010 [cited 2023 Jan 31];16:243-4. Available from:

Diagnostic gastroscopies are the most commonly performed endoscopic procedures with an incidence of about 8.6 per 1000 of population. [1] The use of conscious sedation has resulted in the widespread acceptance of this procedure among both physicians and patients; however, these sedatives frequently cause significant oxygen desaturation, occasionally a cardiopulmonary complication and rarely death. Arrowsmith et al. reported that 1 in 200 American patients undergoing endoscopy experience a cardiorespiratory complication as a direct result of sedation. [2]

Sedation is estimated to be directly responsible for between 30 and 50% of all equipment, supply and labor costs associated with diagnostic upper gastrointestinal endoscopy. [3]

Intravenous sedation usage varies widely between different countries and cultures. Sedation is rarely used in Japan or other Asian countries, the Middle East and South America. Unsedated endoscopy is also the norm in most European countries including Germany, Greece, Spain, Sweden and Switzerland. [4] In contrast, up to 98% of the American patients undergoing gastroscopy receive sedation. [5]

In a British study, the sedation rate for out-patient diagnostic endoscopy decreased by 54%, from as high as 70% in 1990 to 32% in 1998 (P < 0.0001). [6]

In general, there is evidence that the low prevalence of unsedated endoscopy is due more to patient reluctance rather than physician preference. [7]

A double-blind Finnish study compared intravenous midazolam alone with each of three other groups: a placebo-controlled no sedation group, a placebo-controlled pharyngeal local anesthetic group and a third control group that was unblended. [8] The patients in the midazolam group were found to be more likely not to remember the procedure and reported more willingness to return for a repeat procedure. The effects were most pronounced in younger patients. In terms of endoscopist assessment, the patients in the midazolam group were rated as easier to intubate by the endoscopist compared with those in the placebo group, but there was no difference between the midazolam group and either the pharyngeal anesthesia or control groups. Interestingly, the midazolam group had a higher endoscopist rating for overall difficulty and retching during the procedure compared with the pharyngeal anesthesia group.

Another study showed that performing endoscopic ultrasound without sedation, even though was less well tolerated, did not lead to longer procedure times, higher risks or increased reluctance to undergo a repeat procedure. [9]

In this issue of this journal, Sachdeva et al. have shown in a prospective, single-blinded study that although the endoscopist felt more comfortable with sedated versus unsedated gastroscopies, there was no significant difference between the two groups in terms of procedural ease or patient satisfaction. [10]

There are many reasons why some patients prefer to undergo gastroscopy without sedation. In our experience, the most common reasons for the patients not opting for unsedated gastroscopy are the lack of requirement for an escort requirement, the fear of the usual sedation-related complications and restrictions on activities for almost one full day. There is another group of patients who want to know the result of their gastroscopy on the spot and who do not want to feel anxious waiting for their next visit. Contrary to the belief of many endoscopists, the time to complete the gastroscopy is comparable in sedated and unsedated gastroscopy. There is, however, a huge difference in the total time from admission to the endoscopy room to eventual discharge (96 and 6 minutes, respectively; our unpublished data).

Finally, we believe, when enough time is taken to address all of these differences with the patients, many patients would consider unsedated gastroscopy.

   References Top

1.Scott BB. Gastroenterology in the trent region in 1992 and a review of changes since 1975. Gut 1995;36:468-72.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Arrowsmith JB, Gerstman BB, Fleischer DE, Benjamin SB. Results from the American Society for Gastrointestinal Endoscopy/U.S. Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc 1991;37:421-7.  Back to cited text no. 2      
3.Mokhashi MS, Hawes RH. Struggling toward easier endoscopy. Gastrointest Endosc 1998;48:432-40.  Back to cited text no. 3  [PUBMED]    
4.Lazzaroni M, Bianchi Porro G. Preparation, premedication and surveillance. Endoscopy 1998;30:53-60.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Keeffe EB, O'Connor KW. Survey of endoscopic sedation and monitoring practices. Gastrointest Endosc 1990;36:S13-8.   Back to cited text no. 5  [PUBMED]    
6.Mulcahy HE, Hennessy E, Connor P, Rhodes B, Patchett SE, Farthing MJ, et al. Changing patterns of sedation use for routine out-patient diagnostic gastroscopy between 1989 and 1998. Aliment Pharmacol Ther 2001;15:217-20.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]  
7.Faulx AL, Vela S, Das A, Cooper G, Sivak MV, Isenberg G, et al. The changing landscape of practice patterns regarding unsedated endoscopy and propofol use: A national Web survey. Gastrointest Endosc 2005;62:9-15.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]  
8.Ristikankare M, Hartikainen J, Heikkinen M, Julkunen R. Is routine sedation or topical pharyngeal anesthesia beneficial during upper endoscopy? Gastrointest Endosc 2004;60:686-94.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]  
9.Bonta PI, Kok MF, Bergman JJ, Van den Brink GR, Lemkes JS, Tytgat GN, et al. Conscious sedation for EUS of the esophagus and stomach: A double-blind, randomized, controlled trial comparing midazolam with placebo. Gastrointest Endosc 2003;57:842-7.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]  
10.Sachdeva A, Bhalla A, Sood A, Duseja A, Gupta V. The effect of sedation during upper gastrointestinal endoscopy. Saudi J Gastroenterol 2010;16:280-4.  Back to cited text no. 10    Medknow Journal  

Correspondence Address:
Abdulrahman M Aljebreen
PO Box 2925, Internal Medicine Department, King Khalid University Hospital, Riyadh-11461
Saudi Arabia
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-3767.70605

Rights and Permissions

This article has been cited by
1 Bilevel positive airway pressure for gastroscopy with sedation in patients at risk of hypoxemia: A prospective randomized controlled study
Shuailei Wang, Ning Shen, Yanling Wang, Nan Cheng, Leijia Li, Shuru Pan, Tuersunayi Aisan, Ziqing Hei, Gangjian Luo, Chaojin Chen
Journal of Clinical Anesthesia. 2023; 85: 111042
[Pubmed] | [DOI]
2 Comparison of oxygen delivery methods during monitored anaesthesia care for flexible endoscopy procedures
ShivangiHarish Agrawal, Birva Khara
Airway. 2022; 0(0): 0
[Pubmed] | [DOI]
3 Anesthesia for GI endoscopy in the era of COVID-19
Basavana Goudra, PreetMohinder Singh
Saudi Journal of Anaesthesia. 2021; 15(1): 27
[Pubmed] | [DOI]
4 Procedural sedation outside the operating room
Jochen Hinkelbein, Jan Schmitz, Massimo Lamperti, Thomas Fuchs-Buder
Current Opinion in Anaesthesiology. 2020; 33(4): 533
[Pubmed] | [DOI]
5 Supraglottic jet oxygenation and ventilation enhances oxygenation during upper gastrointestinal endoscopy in patients sedated with propofol: a randomized multicentre clinical trial
Y. Qin, L.Z. Li, X.Q. Zhang, Y. Wei, Y.L. Wang, H.F. Wei, X.R. Wang, W.F. Yu, D.S. Su
British Journal of Anaesthesia. 2017; 119(1): 158
[Pubmed] | [DOI]
6 Acupuncture for discomfort in patients during gastroscopy: a systematic review protocol
W. Wang,T. Zhang,W. Peng,J. Wu,Z. Liu
BMJ Open. 2014; 4(9): e005735
[Pubmed] | [DOI]
7 Unsedated versus sedated gastrointestinal endoscopy: A questionnaire investigation in Wuhan, central China
Hong-ling Wang,Fen Ye,Wen-fei Liao,Bing Xia,Guo-rong Zheng
Journal of Huazhong University of Science and Technology [Medical Sciences]. 2013; 33(6): 857
[Pubmed] | [DOI]
8 Safety and acceptance of non-sedated upper gastrointestinal endoscopy: A prospective observational study
Garg, P.K. and Singh, A.P. and Jain, B.K. and Bansal, A. and Mohanty, D. and Agrawal, V.
Journal of Laparoendoscopic and Advanced Surgical Techniques. 2012; 22(4): 315-318
9 Safety and Acceptance of Non-Sedated Upper Gastrointestinal Endoscopy: A Prospective Observational Study
Pankaj Kumar Garg,Abhishek Pratap Singh,Bhupendra Kumar Jain,Amit Bansal,Debajyoti Mohanty,Vivek Agrawal
Journal of Laparoendoscopic & Advanced Surgical Techniques. 2012; 22(4): 315
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


 Article Access Statistics
    PDF Downloaded678    
    Comments [Add]    
    Cited by others 9    

Recommend this journal