LAUSR

Evaluation of the esophagogastric junction (EGJ) area is essential for detecting EGJ cancer including Barrett's adenocarcinoma. The aim of this study is to analyze the factors of difficulty in endoscopic EGJ evaluation. Data were collected retrospectively from consecutive subjects who underwent esophagogastroduodenoscopy (EGD) for medical examination/health checkup in our institution between April 2013 and March 2014. The EGJ observed was assessed during both insertion and withdrawal of the EGD. The difficulty level of endoscopic EGJ evaluation was classified into two groups: an easy-evaluation (100% of the EGJ) and a difficult-evaluation (Not 100% of the EGJ) group. Midazolam was used as a sedative. We compared ages, genders, heights, weights, BMIs, coexisting heart and pulmonary diseases, gastric ulcers, sedations with midazolam and hiatal hernias between the two groups. The study included 692 patients (mean age 65.4 ± 12.4 years, 327 females). The easy-evaluation group comprised 575 cases (83.1%) and the difficult-evaluation group comprised 117 cases (16.9%). In the easy- and difficult-evaluation groups, the numbers of sedated cases were 348 (60.5%) and 96 (82.1%), the numbers of cases without esophageal hiatal hernia were 299 (52.0%) and 83 (70.9%), respectively. The cases that was sedated with midazolam and without esophageal hiatal hernia were identified as independent risk factors associated with difficulty in observation of the EGJ (for both factors, P < 0.001), and their odds ratios were 3.16 and 2.30, respectively. There were no other factors associated with difficulty in observation of the EGJ. Sedation with midazolam and without esophageal hiatal hernia causes difficulty in endoscopic observation of the EGJ. All authors have declared no conflicts of interest.