Patient anxiety and elective gastrointestinal endoscopy

Background: Esophagogastroduodenoscopy (EGD) and colonoscopy (CS) are commonly performed procedures that can cause anxiety related to potential findings, embarrassment and concern over discomfort. The objective of this study is to evaluate patient anxiety associated with diagnostic, sedated outpatient endoscopy and to correlate endoscopists' estimations of patient anxiety with those of the patient. Methods: Consecutive patients referred for diagnostic upper endoscopy or colonoscopy were evaluated. Anxiety was rated at baseline and immediately before the procedure using the State-Trait Anxiety Index (STAI-Y). Patients were categorized as whether they had been previously seen by a gastroenterologist in the clinic or were referred directly by another physician for endoscopy. Patients were also asked to rate their knowledge of the procedure using a visual analog scale. Physicians rated patient anxiety and procedure difficulty using 100 mm visual analog scales. Sedation administered during each procedure was recorded. Results: Ninety-four patients were enrolled; 47 had been referred from the gastroenterology clinic and 47 had been directly referred from primary care physicians. Thirty-nine percent completed baseline and pre-procedure STAI-Y. Endoscopy was associated with a significant increase in state anxiety (baseline, 31.2 +/- 1.8; procedure, 39.8 +/- 2.2; P = 0.00 1) but not trait anxiety (baseline, 35.4 +/- 1.7; procedure, 36.2 +/- 1.6; P = 0.59). Procedural state anxiety was not influenced by age, sex, referral source, type of procedure or perceived procedural knowledge but was correlated with trait anxiety (r = 0.38; P = 0.02). Physician estimates of patient anxiety did not correlate with either procedural state anxiety (r = -0.15; P = 0.37) or the change in state anxiety from baseline to the procedure (r = -0.04; P = 0.82). Conclusions: Diagnostic outpatient endoscopy is associated with modest increases in state anxiety that are not significantly influenced by age, sex, procedure type, indication, or referral source. Endoscopists' ability to estimate patient anxiety is poor but this may reflect the generally mild increases in state anxiety that were encountered.