Meperidine as the Single Sedative Agent During Esophagogastroduodenoscopy

• patient and endoscopist satisfaction score [ Time Frame: 9 months ] [ Designated as safety issue: No ]
  patient and endoscopist satisfaction with the procedure, score 0(not satisfied at all)-10 (very satisfied
• patient tolerance of the procedure [ Time Frame: 9 months ] [ Designated as safety issue: No ]
  patolerace of the EGD, evaluate by the endoscopist, score 0 (best tolerance)-10 (very poor tolerance, the procedure could not be completed)
• endoscopist perception of patient tolerance , [ Time Frame: 9 months ] [ Designated as safety issue: No ]
  endoscopist evaluation of patient tolerance during EGD, score 0 (best tolerance)- 10 (worst tolerance, the procedure can not be completed)

Upper endoscopy is uncomfortable for most patients. Meperidine has both sedative and analgesic effects, so its use may be helpful for patients receiving upper endoscopy.

Unsedated esophagogastroduodenoscopy (EGD) is a useful tool for upper gastrointestinal tract examination and therapy, but it is uncomfortable for many patients. Meperidine has been widely used in colonoscopic examination for many years; however, its use in EGD has not been completely evaluated.

• Drug: Meperidine
  intramuscular, 25 mg, 5 to 10 minutes before EGD
• Drug: normal saline
  25 ml of normal saline, intramuscular, 5 to 10 minutes before EGD

• Experimental: meperidine
  25 mg of meperidine is injected intramuscularly before EGD
  Intervention: Drug: Meperidine
• Placebo Comparator: placebo
  placebo was given intramuscularly before EGD
  Intervention: Drug: normal saline

• Abraham NS, Fallone CA, Mayrand S, Huang J, Wieczorek P, Barkun AN. Sedation versus no sedation in the performance of diagnostic upper gastrointestinal endoscopy: a Canadian randomized controlled cost-outcome study. Am J Gastroenterol. 2004 Sep;99(9):1692-9.
• Ishido S, Kinoshita Y, Kitajima N, Itoh T, Nishiyama K, Tojo M, Yano T, Inatome T, Fukuzaki H, Chiba T. Fentanyl for sedation during upper gastrointestinal endoscopy. Gastrointest Endosc. 1992 Nov-Dec;38(6):689-92.
• Laluna L, Allen ML, Dimarino AJ Jr. The comparison of midazolam and topical lidocaine spray versus the combination of midazolam, meperidine, and topical lidocaine spray to sedate patients for upper endoscopy. Gastrointest Endosc. 2001 Mar;53(3):289-93.
• Diab FH, King PD, Barthel JS, Marshall JB. Efficacy and safety of combined meperidine and midazolam for EGD sedation compared with midazolam alone. Am J Gastroenterol. 1996 Jun;91(6):1120-5.

Inclusion Criteria:

• Patients undergoing diagnostic upper endoscopy in our endoscopic room were enrolled.

Exclusion Criteria:

• A therapeutic upper endoscopic procedure, sedated endoscopy, contraindication to Buscopan (hyoscine N-butylbromide)
• Allergy to meperidine
• American Society of Anesthesiology (ASA) risk Class 3 or higher
• Renal failure
• Decompensated cirrhosis
• Aged less than 20 years or more than 65 years
• Pregnancy
• Refusal to provide written informed consent.