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Stimulating peristalsis improves esophagogastric junction observation during sedated esophagogastroduodenoscopy in children and adolescents

Journal Volume 85 - 2022
Issue Fasc.1 - Original articles
Author(s) A. Morita 1 2 3 #, Y. Nakayama 1 4 #, A. Horiuchi 1, I. Horiuchi 1, H. Takada 2 3
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Full Article
PAGES 15-19
(1) Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan
(2) Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
(3) Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
(4) Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
(#) Contributed equally

Background and study aims: Sedation impairs full visualization of the esophagogastric junction (EGJ) and Z line (the squamocolumnar junction) during esophagogastroduodenoscopy (EGD). The aim of this study was to determine whether induction of esophageal peristalsis could improve the ability to evaluate the Z line in children and adolescents.

Patients and methods: Study 1: Consecutive patients (10-15 years) undergoing EGD with propofol or midazolam sedation were enrolled. The proportion of Z line observed was compared between the two groups. Study 2: The effect of an air infusion near the EGJ following deflation of the stomach to induce esophageal peristalsis was investigated in the patients (15-18 years), undergoing EGD with propofol sedation. The proportion of Z line observed was compared between the stimulated group and control group.

Results: Study 1: 149 patients were evaluated; 87 received propofol (43 boys; average age 13.2 years (range, 10-15)) and 62 received midazolam (30 boys; average age 12.8 years (range, 10-15)). The proportion of the Z line visualized was low but was greater with propofol vs. midazolam sedation (36.8% vs 16.1%, P=0.0059). Study 2: 102 patients were evaluated; 62 had induction of peristalsis (34 boys; average age 16.2 years (range, 15-18)) and 40 controls (20 boys; average age 16.8 years (range, 15-18)). Complete visualization of the Z line achieved in 95% (59 of 62) following induction of peristalsis vs. 37.5% (15 of 40) of controls (P<0.001).

Conclusions: Induction of esophageal peristalsis greatly improved visualization of the Z line during sedated EGD in children and adolescents.

Keywords: esophagogastroduodenoscopy, esophagogastric junction, Z line, sedation, peristalsis, children and adolescents.

The authors declare that they have no conflict of interest.
© Acta Gastro-Enterologica Belgica.
PMID 35304989