Abishek Sasidharan
BACKGROUND
40-47% of patients poorly tolerates esophagogastroduodenoscopy (EGD). Early identification of potentially intolerant patients
improve procedural success and avoid patient discomfort. Modified Mallampati Classification (MMC) score is a simple scoring
system used to predict difficult tracheal intubation and laryngoscope insertion. As EGD involves the same level of patient
discomfort during introduction, MMC may predict EGD tolerance.
MATERIALS AND METHODS
100 patients with dyspeptic symptoms and no alarm features attending our department were recruited for unsedated EGD
between January and July 2012. All patients had good performance status and underlying anxiety disorder was excluded. Based
on MMC, patients placed into 4 classes- I: Soft palate, fauces, pillars and uvula visible. II: Soft palate, fauces and uvula visible.
III: Soft palate and base of uvula visible. IV: Soft palate not visible. They were divided into good view (class I and II) and poor
view (class III and IV). EGD was performed by the same consultant and MMS status assessed by two independent trained
personnel. All received 2 doses of topical pharyngeal spray containing 10% lidocaine hydrochloride. Outcome measurements
were gag reflex, endoscopist’s assessment and patient feedback.
RESULTS
Of 100 patients, 52 were males. 58 in group A and 42 in group B. Gag reflex was present in 32.7% of good view group compared
to 78.6% in poor view (p<0.001). From the endoscopist’s view, good tolerability observed in 72.4% of good view group
compared to 21% in poor view (p<0.001). 74.1% patient reported satisfactory feedback in good view group compared to 19%
in poor view group (p<0.001).
CONCLUSION
MMC is a good clinical indicator for predicting tolerance in unsedated EGD.
