Background: Upper gastrointestinal (GI) endoscopy, while essential for diagnosis and treatment, often causes discomfort and anxiety. This study evaluates the effectiveness of immersive virtual reality (VR) as a distraction tool to improve patient comfort, reduce pain and anxiety, and assess its impact on physician stress during esophagogastroduodenoscopy (OGD) under local anesthesia without sedation. Materials and methods: A randomized open-label clinical trial was conducted on patients undergoing diagnostic OGD for indications such as gastritis, reflux, ulcers, and upper GI bleeding. Participants were assigned to either a control group undergoing standard OGD with xylocaine spray or an intervention group experiencing VR-assisted OGD using MetaQuest Oculus 2. Baseline demographics, general health (RAND-36), and prior endoscopy or VR experience were recorded. Anxiety and pain were assessed using validated scales (State-Trait Anxiety Inventory and visual analog scale). Vital signs were monitored throughout the procedure. Physician stress levels were rated on a scale of 1–3. VR training was provided pre-procedure, and patients remained immersed for 10 minutes post-procedure. To ensure transparency in manuscripts employing artificial intelligence–enhanced methods or writing assistance, compliance with the 2025 TITAN guideline was followed in this study. Results: The VR group showed a 22% reduction in self-reported pain levels. Procedure time was shorter in the VR group (average 5.17 min vs. 5.97 min), though not statistically significant. Surgeon stress scores were lower in the VR-assisted group compared with controls. No significant difference in pre-procedural anxiety scores was observed between the groups. No complications or cybersickness was reported. Conclusion: VR-assisted endoscopy is a promising non-pharmacological tool that significantly reduces patient discomfort and physician stress without sedation and without compromising procedural success. Its low cost, accessibility, and patient acceptance support its broader implementation. Future studies should explore VR as a potential alternative to sedation and refine objective markers of pain and stress in endoscopic procedures.
Akileshwar et al. (2026) studied this question.