# Impact of reducing the duration of fasting and no drinking on the experiences of older patients receiving painless gastroscopy: a randomized controlled trial

## TL;DR

Reducing fasting time before painless gastroscopy improves comfort and satisfaction in older patients without increasing risks.

## Contribution

A new protocol for pre-procedural fasting in older patients undergoing painless gastroscopy that enhances comfort while maintaining safety.

## Key findings

- Reduced fasting time significantly lowered symptoms like thirst, hunger, dizziness, and fatigue in older patients.
- Patient satisfaction was higher in the group with reduced fasting duration.
- No significant increase in adverse events like gastric reflux or aspiration was observed.

## Abstract

Before undergoing painless gastroscopy, patients are required to fast and no drinking for at least 4 h which is unpleasant for older patients.

The aim of this study is to increase the preprocedural comfort of older patients by reducing the duration of fasting and no drinking before painless gastroscopy while ensuring safety.

Older patients aged more than 65 years who underwent painless gastroscopy were randomly allocated to the study group (n = 452) and the control group (n = 452). Those in the study group consumed 250 ml of opaque liquid 4 h prior to painless gastroscopy and 250 ml of water 2 h before the procedure. Those in the control group consumed the same food and water as those in the study group for 6–8 and 4 h, respectively. The primary outcome was patient comfort before the examination. The secondary outcomes included safety, gastroscopy effect and satisfaction in each group. All outcomes were analyzed using both intention-to-treat (ITT) and per-protocol (PP) approaches.

In the study group, the incidence of thirst, hunger, dizziness, and fatigue before gastroscopy was significantly lower than that in the control group (33.4% vs. 42.7%, 20.1% vs. 28.1%, 3.1% vs. 7.5% and 4.9% vs. 11.7%, respectively; all P < 0.01). However, in the gastroscopic assessments of both groups, only a small fraction of the patients exhibited gastric reflux, gastric fluid or food retention, aspiration pneumonia (2.0% vs. 0.9%, 4.4% vs. 3.1%, 1.5% vs. 1.1%, 0.4% vs. 0.2%, respectively; all P > 0.05).Additionally, there was no difference in visual field clarity between the two groups (1.00 (1.00, 2.00) vs. 1.00 (1.00, 2.00), P > 0.05), but the satisfaction of the study group was significantly greater than that of the control group (97.00 (96.00, 99.00) vs. 93.00 (92.00, 95.00), P < 0.01).

In this random trial of older patients undergoing painless gastroscopy, ingestion of 250 ml opaque liquid 4 h before, followed by 250 ml water 2 h before, improved pre-procedure comfort and patient satisfaction compared with conventional fasting. We observed no statistically significant increase in clinically identified gastric reflux, aspiration, or impaired endoscopic field clarity; however, the incidence of such adverse events was low, and the trial was not powered to exclude small increases in rare but serious complications. Larger studies would be required to definitively establish safety equivalence.