The effect of sedation on the quality of upper gastrointestinal endoscopy. Letter to Dr. Meining et al.: Sedation and the quality of upper gastrointestinal endoscopy

We read with great interest the article by Meining et al. [1] on the effect of sedation on the quality of upper gastrointestinal endoscopy, which reported an investigator-blinded, randomized study comparing propofol with midazolam. The paper is interesting, its design is straightforward, and it was an impeccably performed study. Indeed, such papers, which aim to assess the influence of medical practice on the quality of healthcare, are much needed.

Dr. Meining and colleagues compared the effect of two types of sedation (midazolam vs. propofol) on the quality of gastroscopy. We wish to draw attention to certain features, however. The quality of any medical activity has four aspects: its scientific and technical quality, in this case the final result of the endoscopy; the quality as perceived by the patient, or patient satisfaction regarding the provision of healthcare; accessibility, i. e. the ease of the test or lack of negative factors facing the patient who is to undergo the test; and its safety, or lack of unexpected secondary effects.

Meining et al. specifically assessed scientific and technical quality and also safety (albeit to a lesser degree because of the small number of patients). As a result, the other two aspects of quality, in particular the quality as perceived by the patients, were overlooked. Today, the performance of technically adequate techniques based on current scientific knowledge - evidence-based medicine - is not enough. Patients should also perceive that they are being provided with the best possible care [2].

Patient dissatisfaction with healthcare provision leads to a loss of faith, both in physicians and in the results of complementary examinations; to noncompliance with prescribed treatments; and to reluctance to agree to further appointments [3]. As a result, healthcare outcomes - and consequently quality - are poorer.

These factors lead us to believe that although the research carried out by Meining et al. is indeed interesting, its efforts to assess quality in upper gastrointestinal endoscopy fall short. We believe that all of the aforementioned aspects, including patient safety and perceived quality or patient satisfaction should be considered in the assessment of overall quality, thus calling for further and more widely ranging research.

Competing interests: None

References

• 1 Meining A, Semmler V, Kassem A M. et al . The effect of sedation on the quality of upper gastrointestinal endoscopy: an investigator-blinded, randomized study comparing propofol with midazolam.  Endoscopy. 2007;  39 345-349
• 2 Sánchez del Río A, Baudet J S, Alarcón-Fernández O. et al . Evaluation of patient satisfaction in gastrointestinal endoscopy.  Eur J Gastroenterol Hepatol. 2007;  19 896-900
• 3 Lechtzin N, Rubin H R, White P. et al . Patient satisfaction with bronchoscopy.  Am J Respir Crit Care Med. 2002;  166 1326-1331