The efficacy of a simple single-paged visual illustration on anxiety during pediatric gastroscopy : a randomized clinical trial

Background and study aims: Pediatric gastroscopy is a widely used invasive procedure and causes significant anxiety. In this prospective trial, the efficacy of a new original single-page illustration in reducing anxiety was evaluated.

Patients and methods: One hundred fifty-two consecutive children aged between 7 and 18 years who were scheduled to undergo gastroscopy were randomized to receive a standard consent form plus the new single-page visual illustration (group I) and the usual text consent brochure (group II). The Hospital Anxiety and Depression Scale (HADS) was administered to mothers just before, at the first hour, and at the second week after gastroscopy. Also, Visual Analogue Scale (VAS) scores were obtained from children to measure anxiety at the same time intervals.

Results: The demographic characteristics of the groups were similar. A higher number of cases refused gastroscopy in group II (p=0.040). The proportion of mothers with significant HADS- Anxiety scores at the baseline evaluation (≥8) was 33.8% in group I, whereas it was 58.1% in group II (p=0.003). This remarkable difference in anxiety was also observed at the first hour and second week. Moreover, significant baseline HADS-Depression scores (≥8) of the mothers were more common in group II (2.7% vs. 12.7%, p=0.028). In addition, overall HADS scores revealed considerably higher values in group II at all time intervals. VAS scores in children revealed significantly less anxiety in group I at both the baseline and the first hour assessment.

Conclusions: Lower anxiety scores were observed in both mothers and children with the incorporation of the single-page illustration. This new modality may provide less anxiety and prevent insufficient comprehension with higher acceptance of gastroscopy.

Keywords: consent, gastroscopy, HADS, VAS, anxiety.