Techniques in unsedated endoscopy

The evolution of gastrointestinal endoscopy in the United States has led to the near-universal practice of performing all endoscopic procedures under conscious sedation. Performing endoscopy without sedation has intuitive benefits and may play a larger role in the future of endoscopic practice. Esophagogastroduodenoscopy (EGD) or esophagoscopy using small caliber endoscopes may be the most promising application of unsedated endoscopy. Most upper endoscopies are done for diagnostic purposes and such unsedated procedures may be completed in less than ten minutes. Unsedated EGD has been shown to be tolerable, feasible, and safe. Despite such reports, unsedated endoscopy has not gained widespread use in the United States. The goals of this chapter are to review the technical aspects of unsedated upper endoscopy in an attempt to promote its more widespread practice.