The effect of pre-procedural anxiety level on the quality of upper GI endoscopy in non-sedated patients: "can the need for sedation be predicted?"

Background: Pre-procedural anxiety is known to impact the quality of upper gastrointestinal endoscopy (esophagogastroduodenoscopy, EGD), particularly in non-sedated patients. Elevated anxiety levels can cause discomfort and reduce procedural success. Objectives: This study aimed to evaluate the effect of pre-procedural anxiety, measured by the State-Trait Anxiety Inventory (STAI), on the quality of EGD and to determine whether anxiety levels can predict the need for sedation. Design: This was a prospective, cross-sectional study conducted at a tertiary care hospital. Methods: This study included 1344 non-sedated patients aged 18-90 years undergoing EGD at Ankara Etlik City Hospital (September 2023-March 2024). Anxiety levels were assessed using STAI before the procedure. Receiver operating characteristic (ROC) analysis determined the optimal STAI-I cutoff for predicting sedation needs. EGD quality was evaluated by examination thoroughness and biopsy adequacy. Logistic regression identified predictors of unsuccessful procedures. Results: The mean participant age was 50.6 years; 47.8% were male. The average STAI-I score was 42.14. ROC analysis identified an STAI-I cutoff of 36, above which unsuccessful procedures were more likely (area under the curve = 0.720, Conclusion: Pre-procedural anxiety, as measured by STAI, significantly affects non-sedated EGD quality. An STAI-I cutoff of 36 predicts the need for sedation. Routine anxiety assessment could enhance sedation strategies, patient satisfaction, and procedure quality.