When Endoscopic Sedation is Not an Option: Insights From a Multicenter on-site Survey on Tolerance for Japanese Gastric Cancer Screening

Objectives

Esophagogastroduodenoscopy (EGD) is widely used for gastric cancer (GC) screening in Japan; however, sedation during EGD is not recommended. We aimed to assess the tolerability of unsedated EGD (USEGD) in the Japanese population.

Methods

Participants who underwent GC screening in Japanese urban areas between July 2021 and December 2022 were included in this study. We conducted a real-time questionnaire survey on USEGD invasiveness in 16 clinics and hospitals. Participants completed a self-report questionnaire, including a six-point face scale, immediately after undergoing USEGD with an ultrathin endoscope for GC screening, and were placed into the tolerable (T group) or intolerable groups (I group) based on the scores 1–3 and 4–6 on the face scale, respectively.

Results

The 1021 participants (median age, 59 years; interquartile range, 59–74 years) consisted of 561 men and 437 women, while 23 preferred not to answer. Of the 777 participants who underwent USEGD using an ultrathin endoscope, 135 (17.4%) were categorized into the intolerable (I) group based on severe distress, and 642 (82.6%) into the tolerable (T) group. Multiple logistic regression analysis revealed that older age (odds ratio [OR]: 0.974; p = 0.008) and prior USEGD experience (OR: 0.527; p = 0.006) were associated with higher tolerability. Conversely, females (OR: 2.498; p < 0.001) and first-time EGD experience (OR: 2.202; p = 0.003) were associated with lower tolerability.

Conclusions

USEGD was generally well-tolerated; however, some participants found it intolerable, even with transnasal endoscopy. Supportive measures for these individuals are essential for sustaining effective screening programs.