Comparison of 2 Hours Fasting with Conventional 8 Hours Fasting Before Undergoing Upper Gastrointestinal Endoscopy

Abstract

Endoscopy is performed in routine to diagnose gastrointestinal diseases. Usually, a patient has fast for 8 hours fast before undergoing endoscopy. But it has also been observed that 2 hours fast can have equal efficacy in clearing upper gastrointestinal tract for diagnosis of gastrointestinal disease and equivalent comfort for endoscopy. Objective: To compare the outcome of upper gastrointestinal endoscopy with 2 hours fasting versus 8 hours fasting (conventional method). Methods: Ninety cases (45 in each group) were enrolled and divided in two groups. Patients randomized to group A were asked to fast for 2 hours before undergoing endoscopy. In group B, patients underwent endoscopy after 8 hours fast. Just before procedure, patients were inquired if they felt hunger, thirst, weakness, anxiety, nausea or discomfort. The gastroenterologist also observed the patient for nausea or regurgitation at intubation, liquid or food stasis, and risk of aspiration during procedure. The quality of endoscopy was noted as gastric mucosa visibility and overall endoscopy quality rate was noted to.  An overall endoscopy quality score >5 was deemed as good quality. Results: In the 2 hours fast group, no patient had hunger, thirst, or weakness before undergoing procedure while 27 (60.0%) patients had anxiety, 13 (28.9%) patients had nausea and 5 (11.1%) patients felt discomfort. In the 8 hours fast group, 5 (11.1%) patients had hunger, but no patient had thirst or weakness before undergoing procedure while 18 (40.0%) patients had anxiety, 13 (28.9%) patients had nausea and 9 (20.0%) patients were feeling discomfort. In 2 hours, fast group, all (100%) patients had comfort with endoscopy. Similarly, in 8 hours fast group, all (100%) patients had comfort with endoscopy. In the 2 hours fast group, gastroenterologist observed nausea in 32 (71.1%) patients, and liquid stasis in 13 (28.9%) patients, while regurgitation at intubation, food stasis, and risk of aspiration were not observed during endoscopy. In the 8 hours fast group, the gastroenterologist observed nausea in 45 (100%) patients, while liquid stasis, regurgitation at intubation, food stasis, and risk of aspiration were not observed during endoscopy. The difference in both groups was highly significant (p<0.05). The overall endoscopy quality rate was 7.47±0.51 in 2 hours fast group and 7.78±0.60 in 8 hours fast group (p<0.05). In both groups, all patients had score 7 or above and hence, a good quality of endoscopy. Conclusion: 2 hours fast prior to endoscopy achieved results equivalent to those achieved after 8 hours fasting. So, as a day case procedure, endoscopy can be performed within same day after 2 hours fast, instead of waiting for 8 prolonged hours.