# When Endoscopic Sedation is Not an Option: Insights From a Multicenter on‐site Survey on Tolerance for Japanese Gastric Cancer Screening

## TL;DR

This study examines how well Japanese people tolerate unsedated endoscopies for gastric cancer screening, finding that most can handle it, though some find it uncomfortable.

## Contribution

The study provides new insights into the tolerability of unsedated endoscopy for gastric cancer screening in Japan.

## Key findings

- 82.6% of participants found unsedated endoscopy tolerable.
- Older age and prior experience improved tolerability, while females and first-time users faced more difficulty.
- Supportive measures are needed for those who find unsedated endoscopy intolerable.

## Abstract

Esophagogastroduodenoscopy (EGD) is widely used for gastric cancer (GC) screening in Japan; however, sedation during EGD is not recommended. We aimed to assess the tolerability of unsedated EGD (USEGD) in the Japanese population.

Participants who underwent GC screening in Japanese urban areas between July 2021 and December 2022 were included in this study. We conducted a real‐time questionnaire survey on USEGD invasiveness in 16 clinics and hospitals. Participants completed a self‐report questionnaire, including a six‐point face scale, immediately after undergoing USEGD with an ultrathin endoscope for GC screening, and were placed into the tolerable (T group) or intolerable groups (I group) based on the scores 1–3 and 4–6 on the face scale, respectively.

The 1021 participants (median age, 59 years; interquartile range, 59–74 years) consisted of 561 men and 437 women, while 23 preferred not to answer. Of the 777 participants who underwent USEGD using an ultrathin endoscope, 135 (17.4%) were categorized into the intolerable (I) group based on severe distress, and 642 (82.6%) into the tolerable (T) group. Multiple logistic regression analysis revealed that older age (odds ratio [OR]: 0.974; p = 0.008) and prior USEGD experience (OR: 0.527; p = 0.006) were associated with higher tolerability. Conversely, females (OR: 2.498; p < 0.001) and first‐time EGD experience (OR: 2.202; p = 0.003) were associated with lower tolerability.

USEGD was generally well‐tolerated; however, some participants found it intolerable, even with transnasal endoscopy. Supportive measures for these individuals are essential for sustaining effective screening programs.