Factors Associated with Belching and Retching during Esophagogastroduodenoscopy and Their Effects on Z-Line Appearance

Background/Aims: Belching and retching tend to cause technical difficulties during endoscopic procedures; however, risk factors associated with belching and retching during endoscopy remain unclear. In this study, we investigated the factors associated with belching and retching during unsedated endoscopy and the effects of belching and retching on the grading of Los Angeles (LA) classification of reflux esophagitis. Materials and Methods: This prospective observational study included patients who underwent unsedated esophagogastroduodenoscopy (EGD). We used a predefined grading system to evaluate belching and retching during the endoscopic examination. LA classification grades were compared between the endoscope insertion and withdrawal phases of EGD. Results: The study included 327 patients. Age (specifically, young age [<60 years]) was significantly associated with belching and retching ( P <0.001). Belching and retching were not associated with statistically significant change of the LA classification ( P =0.962). However, we observed differences in Z-line appearance between the endoscope insertion and withdrawal phases in several patients. Conclusions: Age was significantly associated with belching and retching during unsedated EGD. Notably, Z-line appearance was also changed during EGD in some patients. (Korean J Helicobacter Up Gastrointest Res 2022;22:295-302)