Patients were asked to eat their usual diet containing food and liquids before entering in the fasting protocols. Those assigned to the conventional fasting period were instructed to remain at least 6 hours in fasting conditions. However, considering that most patients had a prescription of non per os after midnight, we decided to standardize these patients as doing an 8 hours fasting.
This solution is a nutritional complement constituted of hyperchaloric 1. It is free of lipids and fibers. A nurse ATK enrolled the participants. After agreement to participate, patients were asked to remain in fasting conditions between 6 and 8 hours before randomization. Two hours prior to endoscopy, patients were randomly assigned to drink ml of clear liquids or to remain fasting.
This technician supervised the intake of clear liquids from F2 patients. The participants Patients were asked to avoid commentaries about their fasting status in the endoscopy room and during post-procedure interview. A nurse ATK blinded to patients fasting status followed all the procedures, taking note of clinical data, indication of endoscopy, patient weight and height, sedatives and procedure length.
Immediately after the end of the endoscopies, the examiners replied to a structured interview designed to assess safety and quality. After recovery from sedation, patients were interviewed by the same nurse to assess comfort. Patient comfort was elected as the primary outcome, given that sample size was calculated according to effect estimation on this parameter.
Endoscopy-related safety and quality were considered as secondary outcomes. Structured interviews were carried out to assess comfort according to patients, and safety and quality according to endoscopists. The questionnaire applied to the patients was composed of 6 questions assessing fasting-related symptoms. The questionnaire applied to the endoscopists included 5 questions regarding safety and 2 questions approaching quality Table 1.
All randomized patients completed the study. Quantitative data were analyzed with Student t test, whereas qualitative data were analyzed using Fisher exact test or chi-square test. A total of patients were interviewed in the enrollment phase of the study Figure 1.
Of these, 17 patients All enrolled patients completed the study protocol and were included in the analysis. The four endoscopists were interviewed immediately after each endoscopy, while the patients were interviewed after recovery from sedation, which occurred on average 4 hours after the procedure.
Basal characteristics of the patients did not differ statistically between F2 and F8 Table 2. Examples are presented in Figure 4. However, no case of pulmonary aspiration was observed in either group. The other parameters did not differ statistically between F2 and F8, including nausea immediately before endoscopy, regurgitation after endoscopic intubation, food stasis in the stomach, and risk of aspiration data not shown.
The amount of midazolan used for sedation was also similar between F2 and F8 6. Among the five patients with diabetes mellitus who fasted 2 hours, there was no case of regurgitation of gastric contents into the esophagus after endoscopic intubation or increased risk of aspiration according to endoscopists judgment.
Safety of endoscopy in patients who fasted 8 F8 or 2 F2 hours. 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. Such score was numerically higher in hospitalized patients who fasted 2 hours compared to outpatients [9 8—10 vs.
Quality of endoscopy in patients who fasted 8 F8 or 2 F2 hours. The aim of this study was to assess comfort, safety and quality of endoscopy under moderate sedation after 2 hours fasting for clear liquids.
For this purpose, we randomly assigned patients who were referred for elective endoscopy to perform the procedure either after a conventional fasting period of 8 hours or after 2 hours fasting for a carbohydrate beverage with rapid gastric emptying [ 22 , 23 ].
Comfort was rated by patients after recovery from sedation, whereas safety and quality were determined by endoscopists, blinded to patients fasting status. In this randomized and controlled trial, we found that upper GI endoscopy after 2 hours fasting for clear liquids was more comfortable than the conventional procedure, particularly in terms of hunger, weakness, anxiety and general discomfort.
We also found that a shorter fasting period did not compromise endoscopy safety. Although overall quality was slightly inferior after a shorter fasting, gastric mucosa visibility was not compromised in patients who drank clear liquids 2 hours before.
To the best of our knowledge, this is the first study evaluating endoscopy-related comfort after ingestion of a carbohydrate solution. Comfort was superior in patients who ingested clear liquids 2 hours before the endoscopy. In this group, fewer patients complained of hunger, weakness, anxiety and general discomfort.
However, no significant advantage was observed in terms of thirst with a shorter fasting. This could be explained by a sweet taste of the ingested fluid. We have to mention other potential benefits of drinking a carbohydrate beverage before endoscopy, such as attenuation of both insulin resistance and organic response to stress [ 24 ]. The practice of a prolonged fasting before elective procedures such as endoscopies and surgeries has been recently questioned by authorities and societies [ 7 , 13 ].
An empty stomach is required to ensure safety of procedures such as upper GI endoscopy [ 1 ]. Studies on gastric physiology have demonstrated that clear liquids are quickly emptied from the stomach, especially if free of lipids [ 25 ]. For instance, the emptying of water begins immediately after ingestion, with a half-emptying time of approximately 20 min. Despite the well-known rapidity of gastric emptying for clear liquids, the presence of residua in the gastric lumen has traditionally been assumed as a concern for pulmonary aspiration during interventions which involve pharyngeal manipulation [ 13 ].
In the present study, the ingestion of ml of clear liquids 2 hours before upper GI endoscopy did not compromise procedure safety, according to evaluation of experienced endoscopists in a blinded fashion setting.
Regurgitation of gastric contents into the esophagus following endoscopic intubation was equally observed in a minority of patients, regardless of fasting 2 or 8 hours. Additionally, neither procedure length nor midazolam dose was modified with a shorter fasting period. Prior reports have demonstrated that the ingestion of clear liquids until 2 hours before general anesthesia does not result in increased amount of gastric residua or changes in gastric pH [ 26 , 27 ].
Others have indicated that a short fasting for clear liquids may be accompanied by a lower amount of liquid in the gastric lumen in comparison to the conventional, longer fasting [ 17 , 19 , 28 ]. In a recent metanalysis, healthy adult participants given a drink of water preoperatively were found to have a significantly lower volume of gastric contents than the group that followed a standard fasting regimen.
However, this difference was modest and clinically insignificant [ 14 ]. It has also been demonstrated that the ingestion of non-caloric solutions such as pronase diluted in ml of water immediately before endoscopy did not compromise endoscopy safety [ 21 ]. Here we observed that patients who fasted 2 hours presented a higher amount of liquid in the gastric lumen than patients who fasted 8 hours, despite of subjective evaluation.
Methodological differences could explain such controversies, pointing to the need of further studies with objective measurement of gastric residua during endoscopy. In our study, endoscopy quality according to endoscopists judgment was considered high in both groups median 9.
Although F8 rate was statistically superior than F2, such difference may be irrelevant from the clinical point of view. In agreement, De Silva et al. Indeed, gastric mucosa visibility was normal in the majority of our patients and did not differ between F2 and F8 according to our endoscopists.
Another recent study have shown that the administration of carbohydrate-rich drink until 2 and 4 hours before general anesthesia did not change quality of endoscopy [ 29 ]. Interestingly, endoscopy quality was higher in hospitalized patients than in outpatients, particularly in those who fasted 8 hours.
This could reflect a more strict preparation carried out in the hospital setting. We acknowledge limitations. Your stomach is an elongated, pear-shaped pouch. It lies across your abdominal cavity to the left, below your diaphragm. Your stomach can typically…. It may be particularly helpful…. Learn the ins and outs of MRI vs.
X-ray imaging tests, including the pros and cons of each test, how they compare to CT scans, how much they cost, and…. Paracentesis is a procedure to remove excess fluid from the abdominal cavity. This fluid buildup is called ascites. Learn about preparation, recovery…. Learn more. An abdominal film is an X-ray of the abdomen. This type of X-ray can be used to diagnose many conditions. Learn more here. The part of your body getting scanned and the number of images needed play a role in determining how long the MRI will take.
Here's what to expect. Health Conditions Discover Plan Connect. How to Prepare for an Endoscopy. Medically reviewed by Carissa Stephens, R. Types of endoscopies. Discuss medical conditions or problems. Mention medications and allergies.
This is for your safety. People with the same or similar names may be having procedures on the same day. The IV will be used to give you anesthesia medication to make you sleep during your procedure. You may also get fluids through the IV before your procedure. Your healthcare provider will set up equipment to monitor your heart, breathing, and blood pressure. Your doctor will take biopsies if needed, then remove the endoscope. Your nurse will continue to monitor your heart, breathing, and blood pressure.
You may feel soreness in your throat. If you do, it should go away in 1 to 2 days. Your nurse will explain your discharge instructions to you before you go home. Your feedback will help us improve the information we provide to patients and caregivers. We read every comment, but we're not able to respond. If you have questions about your care, contact your healthcare provider.
For more resources, visit www. This information will help you get ready for your upper endoscopy. Back to top 1 Week Before Your Procedure Ask about your medications You may need to stop taking some of your medications before your procedure.
0コメント