August, 2006

The Value of Endoscopy
Endoscopy is the visual examination of the esophagus, stomach and the duodenum (the first part of the small intestine) using a lighted, thin flexible tube (an "endoscope"]. Nearly 5.7 million inpatient and outpatient gastrointestinal endoscopies are performed yearly in the United States (Hall and Lawrence, 1998; Fastats, 2006).

Endoscopy is a valuable, safe procedure to investigate various problems, such as trouble swallowing, nausea, vomiting, reflux, bleeding, indigestion, abdominal pain, or chest pain. It is the best way of diagnosing many problems in the digestive tract, including ulcers, cancer, bleeding, and hernias. It also makes it possible for some people to avoid surgery for abnormal vessels, ulcers, narrowing of passageways, polyps, and some tumors (Ravenscroft and Swan, 1984).

Problems with Endoscopy
Many patients avoid recommended endoscopies out of fear of the procedure, or of what the procedure will find. Studies show that pre-endoscopic anxiety is a significant problem and that providing information about the procedure can reduce anxiety and improve acceptance of the procedure (Bebbensleben and Rohde, 1990; Luck, Pearson et al, 1999).

Distress due to gagging and intestinal cramping can make endoscopy much harder for both patient and provider and sometimes prevents completion of the examination. Intravenous sedation may cause low oxygen and low blood pressure in some patients (Ravenscroft and Swan, 1984).

The Role of Relaxation and Imagery
Many studies have shown that relaxation with distraction, guided imagery, hypnosis, cognitive behavioral changes, deep breathing, and/or music can reduce patient discomfort, lower anxiety, and raise patient tolerance of and satisfaction with the procedure. They can also reduce need for sedation in endoscopies and other procedures (Bampton and Draper, 1997; Cataldo, 1996; Diette, Lechtzin, et al, 2003; Gattuso, Litt and Fitzgerald, 1992; Lang, Benotsch, et al, 2001; Maguire, Walsh, and Little, 2004; Salmore and Nelson, 2000; Zimmerman, 1998).

Procedures also tended to go more smoothly and require less time (Zimmerman; Lang, Benotsch, et al.). Reduced sedation decreases complications and cuts the need for expensive monitoring. It also allows patients and caregivers to quickly return to their daily lives (Cataldo). Increased satisfaction improves willingness to have future procedures, if necessary.

Guided imagery is a safe and effective method that can increase patient compliance and satisfaction with endoscopy. Guided Imagery can reduce the need for sedation, leading to direct cost savings and reduced chance of complications.

Bampton P, Draper B. Effect of relaxation music on patient tolerance of gastrointestinal endoscopic procedures. Journal of Clinical Gastroenterology. 1997 25:343-5.

Bebbensleben B, Rohde H. [Anxiety before gastrointestinal Endoscopy – a significant problem?] Deutsch Med Wochenschr. 1990 115:1539-44 (abstract).

Cataldo PA. Colonoscopy without sedation. Diseases of the Colon and Rectum. 1996 3:257-61.

Diette GB, Lechtzin N, Haponik E, Devrotes A, Rubin HR. Distraction therapy with nature sights and sounds reduces pain during flexible bronchoscopy: a complementary approach to routine analgesia. Chest. 2003 Mar;123(3):941-8.

[no author cited] Fastats. Inpatient Procedures (2004). National Center for Health Statistics. http://www.cdc.gov/nchs/fastats/insurg.htm
Accessed August, 2006.

Gattuso SM, Litt MD, and Fitzgerald TE. Coping with gastrointestinal endoscopy: Self-efficacy enhancement and coping style. Journal of Consulting and Clinical Psychology. 1992 60:133-139.

Hall MJ, Lawrence. Ambulatory Surgery in the United States: 1996. Advanced Data No. 300, Aug. 12, 1998. National Center for Health Statistics. Table 4, pg. 7.
Accessed August, 2006.

Lang E, Benotsch EG, Fick LJ, Lutgendorf S, Berbaum ML, Berbaum KS, Logan H, Spiegel D. Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomized trial. Lancet. 2001 355:1486-1490.

Luck A, Pearson S, Maddern G, Hewett P. Effects of video information on precolonoscopy anxiety and knowledge: a randomised trial. Lancet. 1999 354(9195):2032-5.

Maguire D, Walsh JC, Little CL. The effect of information and behavioural training on endoscopy patients' clinical outcomes. Patient Educ Couns. 2004 Jul;54(1):61-5.

Ravenscroft, MM and Swan, CHJ. (1984). Gastrointestinal Endoscopy and Related Procedures, Cambridge UK: Chapman and Hall Ltd. pp 59-102.

Salmore RG, Nelson JP. The effect of preprocedure teaching, relaxation instruction, and music on anxiety as measured by blood pressures in an outpatient gastrointestinal endoscopy laboratory. Gastroenterol Nurs. 2000 23: 102-110.

Zimmerman J. Hypnotic technique for sedation of patients during upper gastrointestinal endoscopy. Ám J Clin Hyp. 1998 40(4): 284-7.