Cardiopulmonary Risk of Esophagogastroduodenoscopy

The impact of endoscope diameter and the presence of systemic sedation on the cardiopulmonary risk of esophagogastroduodenoscopy was investigated. One hundred and forty-six patients undergoing elective esophagogastroduodenoscopy were randomly assigned to one of three groups which differed in either endoscope diameter or use of sedation: group 1 (8.5-mm endoscope with no sedation), group 2 (8.5-mm endoscope with diazepam), and group 3 (11.5-mm endoscope with diazepam). Esophagogastroduodenoscopy was tolerated best by group 2, and this group had the fewest electrocardiographic changes observed on a HoJter recording during esophagogastroduodenoscopy. The incidence of electrocardiographic changes during esophagogastroduodenoscopy correlated with patient tolerance (p < 0.001) and the use of the smaller endoscope (p < 0.05). The most common arrhythmia was sinus tachycardia (49 patients), but more serious electrocardiographic changes were observed in 21 patients. Serious arrhythmias were more common in patients with a prior history of cardiovascular disease compared with patients with no such history (30% vs. S%, p < 0.001). Arterial oxygen desaturation (measured by ear oximetry) during intubation and esophagogastroduodenoscopy was usually modest (2%-5%). However, 16 patients receiving diazepam