Comfort, safety and quality of upper gastrointestinal endoscopy after 2 hours fasting: a randomized controlled trial

Angélica Terezinha Koeppe, Marcio Lubini, Nilton Maiolini Bonadeo, Iran Moraes Jr, Fernando Fornari, Angélica Terezinha Koeppe, Marcio Lubini, Nilton Maiolini Bonadeo, Iran Moraes Jr, Fernando Fornari

Abstract

Background: Upper gastrointestinal endoscopy has been performed after fasting 8 or more hours, which can be harmful to the patients. We assessed comfort, safety and quality of endoscopy under moderate sedation after 2 hours fasting for clear liquids.

Methods: In this clinical trial, patients referred for elective endoscopy were randomly assigned to a fasting period of 8 hours (F8) or a shorter fasting (F2), in which 200 ml of clear liquids were ingested 2 hours before the procedure. Endoscopists blinded to patients fasting status carried out the endoscopies. Comfort was rated by the patients, whereas safety and quality were determined by the endoscopists.

Results: Ninety-eight patients were studied (aging 48.5 ± 16.5 years, 60% women): 50 patients (51%) in F2 and 48 in F8. Comfort was higher in F2 than F8 in regard to anxiety (8% vs. 25%; P = 0.029), general discomfort (18% vs. 42%; P = 0.010), hunger (44% vs. 67%; P = 0.024), and weakness (22% vs. 42%; P = 0.034). Regurgitation of gastric contents into the esophagus after endoscopic intubation did not differ between F2 and F8 (26% vs. 19%; P = 0.471). There was no case of pulmonary aspiration. Gastric mucosal visibility was normal in most patients either in F2 or F8 (96% vs. 98%; P = 0.999).

Conclusions: Elective upper GI endoscopy after 2 hours fasting for clear liquids was more comfortable and equally safe compared to conventional fasting. This preparation might be cautiously applied for patients in regular clinical conditions referred for elective endoscopy.

Trial registration: SAMMPRIS ClinicalTrial.gov number, NCT01492296.

Figures

Figure 1
Figure 1
Enrollment, randomization and follow-up of participants.
Figure 2
Figure 2
Comfort of patients who fasted 8 (F8) or 2 (F2) hours.
Figure 3
Figure 3
Safety of endoscopy in patients who fasted 8 (F8) or 2 (F2) hours.
Figure 4
Figure 4
Endoscopic view of the gastric lumen of patients who fasted 8 (F8) or 2 (F2) hours. Note that the amount of liquid is subjectively higher in F2 patient. (A and B: frontal view of the gastric corpus in F8 and F2, respectively; C and D: retroview of the fundus in F8 and F2, respectively).
Figure 5
Figure 5
Quality of endoscopy in patients who fasted 8 (F8) or 2 (F2) hours.

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