Duration of Esophagogastroduodenoscopy Procedures

I read with interest the articles by Preiss et al. [ 1 ] and Birkner et al. [ 2 ] published in the August 2003 issue of Endoscopy, comparing standard peroral, ultrathin peroral, and transnasal esophagogastroduodenoscopy (EGD). The two articles provide comprehensive data and describe adequate methodologies, but ultimately reached different conclusions. One difference between the two sets of data is striking: the mean duration of an EGD procedure (with no significant difference between the technique used) was 9.1 ± 2.4 min in Düsseldorf, compared with 4 - 5 min (range 2 - 6 min) in Munich. As an endoscopy practitioner, I suspect that the duration of an unsedated EGD has a major impact on its tolerance. Most senior endoscopists I know would need no more than 3 min to carry out a routine, standard peroral diagnostic EGD with optimal diagnostic performance, and this may explain why they do not need to use sedation in 44 % of their patients. My impression is that the wide range of procedure durations raises a few questions about the validity of these studies. Are we talking about the same procedure when it lasts 4 or 9 min, if tolerance issues are taken into consideration? Just how much time should we need for an EGD? Is it surprising that the ”4-min EGD” team concludes that alternatives to the standard peroral route are of little interest?