One hour fast for liquids prior to upper gastrointestinal endoscopy seems safe, effective and results in minimum patient discomfort

Abstract

INTRODUCTION: Current guidelines for upper gastrointestinal endoscopy advice at least 6-8 hours fasting for solids and at least 4 hours for liquids. Studies have shown that is uncomfortable and probably unnecessary. A study was done by us using real-time ultrasonography on 10 patients established the minimal time for clearing non-opaque liquids was one hour. Aims: To determine the effects of allowing clear liquids one hour prior to endoscopy. METHODS: 40 patients referred for video endoscopy, without alarm symptoms or clinically obvious motility problems, were recruited. Patients were given a standard meal 6 hours before endoscopy. They were then randomized to either fasting for 6 hours (group A, n=20) or allowed to take clear fluids up to one hour prior to endoscopy (group B, n=20). Just prior to endoscopy patients indicated discomfort due to fasting on a visual analog scale (0-no discomfort to 10-severe discomfort). All endoscopies were done by a single investigator blinded to the period of fasting. Presence of fluid in the gastric fundus was noted, and endoscopic vision was graded as good, average or poor. RESULTS: Discomfort was significantly lower in group B than group A (mean visual analog score 0.3 vs. 4.4; p<0.001, Wilcoxon two-sample test). Endoscopic vision was good in all 20 patients in group A and 18 in group B, and average in 2 in group B. None were graded as poor. Fluid in the gastric fundus was noted in 6 patients in group A and 7 in group B. CONCLUSIONS: Allowing clear liquids for up to one hour prior to endoscopy seems acceptable, and causes minimum discomfort to patients. However, a larger study should be performed before revision of current guidelines can be made.