High Prevalence of Patient Intolerance to Unsedated Esophagogastroduodenoscopy: A Cross-Sectional Study in a Portuguese Population

Introduction: Esophagogastroduodenoscopy (EGD) is a diagnostic and therapeutic procedure increasingly performed worldwide that can be done with or without sedation. Aim: To evaluate how common EGD intolerance without sedation is among a group of patients in a Western country. Methods: A cross-sectional study at a Portuguese hospital reviewed EGD procedures without sedation from January 2021 to March 2024. Reports indicated patient tolerance (well-tolerated or intolerant). Only patients aged 18 or older were included. When patients had multiple EGDs without sedation within the analysis period, only the first procedure was analysed. Data collected from endoscopy reports included gender, age, EGD setting, and a history of previous upper gastrointestinal tract surgery. Results: This study involved 849 patients who underwent unsedated EGD, with 452 males and 397 females. Of these, 258 patients (30.4%) did not tolerate the procedure. Younger patients (under 50 years old) exhibited significantly higher intolerance than older patients, with adjusted odds ratio (AOR) of 3.14 (95% CI 2.06–4.79, p<0.001). Additionally, females showed greater intolerance compared to males, with an AOR of 1.41 (95% CI 1.04–1.90, p=0.025). Conclusion: Approximately one-third of patients are unable to tolerate EGD without sedation. Younger age (<50 years) and female gender were independent predictors of intolerance to unsedated EGD. This high prevalence highlights the importance of providing sedation during EGD to decrease patient discomfort, avoid the need for a repeat EGD due to an inconclusive unsedated first attempt, improve diagnostic accuracy by meeting performance standards, and reduce the risk of missing precancerous conditions or lesions.