Introduction Tolerability of endoscopy is variable, with pain and distress influencing overall experience. Currently, there is a paucity of work evaluating distress, with no reliable tools established as predictors of endoscopic tolerability. A recent study found higher levels of discomfort during colonoscopy in patients scoring 11 or more (out of a maximum of 21) on the anxiety portion of the HADS questionnaire evaluated post-procedure.¹ Our study evaluates the pre-endoscopic use of HADS and its value in predicting procedural pain and distress.

Methods Consecutive patients attending for clinically indicated OGD or colonoscopy were prospectively recruited between September 2011 and June 2012 at a University hospital. Prior to endoscopy, patients completed the HADS questionnaire and were familiarised with the 10-point numeric rating scale used to assess expected pain and distress and post-procedural pain and distress. Patients with high HADS anxiety scores (HADS≥11) were then compared with those with low scores (HADS≤10), with the cut off value of 11 defined in accordance with the original HADS paper.2 Data was analysed using SPSS version 20, with a Mann Whitney U test used to determine differences between procedural pain and distress scores.

Results 610 patients were prospectively recruited (280 male patients, median age 56 years, range 17–90 years, 306 OGD’s), with 21% (128/610) having HADS anxiety scores > 11. Of these individuals, 51% (65/128) had elevated procedural pain, with 53% (68/128) having elevated procedural distress. By comparison in patients with HADS anxiety scores < 10, only 32% (154/482) had elevated procedural pain and 37% (176/482) had elevated distress. Comparisons between the two groups (HADS≥11 and those with HADS ≤10) demonstrated significant differences (p = 0.001 for pain and p < 0.001 for distress). Median scores for the two groups are highlighted in Table 1.

Conclusion This is the first study demonstrating how the HADS could be used to predict endoscopic tolerability, with HADS anxiety scores ≥11 associated with over a 50% chance of having procedural pain and distress. Adopting HADS into pre-endoscopy assessments could help identify patients likely to poorly tolerate endoscopy, leading to earlier consideration of sedation, analgesia and other endoscopic measures to minimise pain and distress.

Disclosure of Interest None Declared.

References

1. Elphick D et al. Factors associated with abdominal discomfort during colonoscopy: a prospective analysis. European Journal of Gastroenterology and Hepatology. 2009 Sep; 21(9):1076–82.

2. Zigmond AS et al. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun; 67(6):361–70