Top

24-04-2024 | Acupuncture

Transcutaneous electric nerve stimulation of acupuncture points improves tolerance in adults undergoing diagnostic upper gastrointestinal endoscopy: a single-center, double-blinded, randomized controlled trial

Authors: Jun Sen Chuah, Jih Huei Tan, Mohamad Adam Bujang, Koon Khee Chan, Nik Ritza Kosai

Abstract

Background

Oesophagogastroduodenoscopy (OGDS) is the most common diagnostic procedure for upper gastrointestinal diseases. It often causes discomfort and anxiety, which are only mitigated by systemic sedation. However, sedation poses additional risks of adverse cardiopulmonary events, increased medical costs, and prolonged recovery. Transcutaneous electrical nerve stimulation of acupuncture points (Acu-TENS) is a non-invasive and innovative approach that induces analgesic effect during endoscopy. This trial is the first to be reported in English that explores the potential of Acu-TENS to increase patient tolerance during non-sedated elective diagnostic OGDS.

Methods

A double-blinded randomized controlled trial involving 348 subjects was conducted at a tertiary hospital to evaluate the success rate of OGDS with Acu-TENS. Subjects aged 18–75 years scheduled for their first elective diagnostic OGDS were randomized into the intervention (Acu-TENS) and placebo arms. OGDS success was assessed based on subjects’ satisfaction ratings on a Likert scale and procedure’s technical adequacy. Secondary measures included subjects’ willingness to undergo future OGDS under similar conditions, procedure duration, and the endoscopist’s perceived ease of the procedure.

Results

OGDS success rates were significantly higher with Acu-TENS (77.8%) than with the placebo (68.0%; odds ratio [OR] 1.64, 95% confidence interval [CI] 1.01–2.66, p = 0.043). Subjects who received Acu-TENS expressed higher willingness for future OGDS (78.9%) than those who received the placebo (68.6%; OR 1.71, 95% CI 1.04–2.79, p = 0.031). Procedure duration were significantly shorter in the intervention arm (6.0 min) than in the placebo arm (10.0 min; p = 0.002). No adverse effects were reported, and endoscopists perceived similar procedure ease in both arms.

Conclusions

Acu-TENS improved OGDS success and enhanced patients’ experiences during non-sedated OGDS. It demonstrated safety with no side effects and reduced the procedure completion time. It could be used as an adjunct in non-sedated diagnostic OGDS.

Available only for authorised users

Malaysian Gastro-intestinal Registry Committee (2018) Malaysian gastro-intestinal registry (MGIR) report 2009–2018. Ministry of Health Malaysia. https://www.crc.gov.my/report-registry/

Lin OS (2017) Sedation for routine gastrointestinal endoscopic procedures: a review on efficacy, safety, efficiency, cost and satisfaction. Intest Res 15(4):456–466. https://doi.org/10.5217/ir.2017.15.4.456CrossRefPubMedPubMedCentral

Early DS, Lightdale JR, Vargo JJ 2nd, Acosta RD, Chandrasekhara V, Chathadi KV, Evans JA, Fisher DA, Fonkalsrud L, Hwang JH, Khashab MA, Muthusamy VR, Pasha SF, Saltzman JR, Shergill AK, Cash BD, DeWitt JM (2018) Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc 87(2):327–337. https://doi.org/10.1016/j.gie.2017.07.018CrossRefPubMed

Abraham NS, Fallone CA, Mayrand S, Huang J, Wieczorek P, Barkun AN (2004) Sedation versus no sedation in the performance of diagnostic upper gastrointestinal endoscopy: a canadian randomized controlled cost-outcome study. Am J Gastroenterol 99(9):1692–1699. https://doi.org/10.1111/j.1572-CrossRefPubMed

Ben-Menachem T, Decker GA, Early DS, Evans J, Fanelli RD, Fisher DA, Fisher L, Fukami N, Hwang JH, Ikenberry SO, Jain R, Jue TL, Khan KM, Krinsky ML, Malpas PM, Maple JT, Sharaf RN, Dominitz JA, Cash BD (2002) Adverse events of upper GI endoscopy. Gastrointest Endosc 76(4):707–718. https://doi.org/10.1016/j.gie.2012.03.252CrossRef

Willey J, Vargo JJ, Connor JT, Dumot JA, Conwell DL, Zuccaro G (2002) Quantitative assessment of psychomotor recovery after sedation and analgesia for outpatient EGD. Gastrointest Endosc 56(6):810–816. https://doi.org/10.1067/mge.2002.129609CrossRefPubMed

Johnson MI, Paley CA, Jones G, Mulvey MR, Wittkopf PG (2022) Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: a systematic review and meta-analysis of 381 studies (the meta-TENS study). BMJ Open 12(2):e051073. https://doi.org/10.1136/bmjopen-2021-051073CrossRefPubMedPubMedCentral

Leung WW, Ng SS, Jones A, Chan SK, Wong CY, Lee JF (2014) Su1581 the application of transcutaneous electric nerve stimulation on acupoints (Acu-TENS) for pain relief during colonoscopy: a prospective, randomized, placebo-controlled study. Gastrointest Endosc 79(5):329. https://doi.org/10.1016/j.gie.2014.02.325CrossRef

Joan Gan CY, Chan KK, Tan JH, Tan Chor Lip H, Louis Ling LL, Mohd Azman ZA (2021) Smartphone-controlled patch electro-acupuncture versus conventional pain relief during colonoscopy: a randomized controlled trial. ANZ J Surg 91(6):E375–E381. https://doi.org/10.1111/ans.16870CrossRefPubMed

10.

Leung WW (2013) Acupuncture transcutaneous electrical nerve stimulation reduces discomfort associated with barostat-induced rectal distension: a randomized-controlled study. World J Gastroenterol 19(3):381–388. https://doi.org/10.3748/wjg.v19.i3.381CrossRefPubMedPubMedCentral

11.

Mitchell AJ, Hall RW, Golianu B, Yates C, Williams DK, Chang J, Anand KJ (2016) Does noninvasive electrical stimulation of acupuncture points reduce heelstick pain in neonates? Acta Paediatr 105(12):1434–1439. https://doi.org/10.1111/apa.13581CrossRefPubMedPubMedCentral

12.

Chao AS, Chao A, Wang TH, Chang YC, Peng HH, Chang SD, Chao A, Chang CJ, Lai CH, Wong AMK (2007) Pain relief by applying transcutaneous electrical nerve stimulation (TENS) on acupuncture points during the first stage of labor: a randomized double-blind placebo-controlled trial. Pain 127(3):214–220. https://doi.org/10.1016/j.pain.2006.08.016CrossRefPubMed

13.

Brown L, Holmes M, Jones A (2009) The application of transcutaneous electrical nerve stimulation to acupuncture points (Acu-TENS) for pain relief: a discussion of efficacy and potential mechanisms. Phys Ther Rev 14(2):93–103. https://doi.org/10.1179/174328809X405964CrossRef

14.

Ghule SB (2020) Effect of accu tens with accu band on nausea, vomiting, retching and quality of life in early pregnancy. Indian J Physiother Occup Ther 14(1):6. https://doi.org/10.37506/ijpot.v14i1.3471CrossRef

15.

Cohen LB, Wecsler JS, Gaetano JN, Benson AA, Miller KM, Durkalski V, Aisenberg J (2006) Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol 101(5):967–974. https://doi.org/10.1111/j.1572-0241.2006.00500.xCrossRefPubMed

16.

Zhou S, Zhu Z, Dai W, Qi S, Tian W, Zhang Y, Zhang X, Huang L, Tian J, Yu W, Su D (2021) National survey on sedation for gastrointestinal endoscopy in 2758 Chinese hospitals. Br J Anaesth 127(1):56–64. https://doi.org/10.1016/j.bja.2021.01.028CrossRefPubMed

17.

Johnson M (2007) Transcutaneous electrical nerve stimulation: mechanisms, clinical application and evidence. Rev Pain 1(1):7–11. https://doi.org/10.1177/204946370700100103CrossRefPubMedPubMedCentral

18.

Au DWH, Tsang HWH, Ling PPM, Leung CHT, Ip PK, Cheung WM (2015) Effects of acupressure on anxiety: a systematic review and meta-analysis. Acupunct Soc 33(5):353–359. https://doi.org/10.1136/acupmed-2014-010720CrossRef

19.

Son CG (2019) Clinical application of single acupoint (HT7). Integr Med Res 8(4):227–228. https://doi.org/10.1016/j.imr.2019.08.005CrossRefPubMedPubMedCentral

20.

Gan TJ, Jiao KR, Zenn M, Georgiade G (2014) A randomized controlled comparison of electro-acupoint stimulation or ondansetron versus placebo for the prevention of postoperative nausea and vomiting. Anesth Analgesia 99(4):1070–1075. https://doi.org/10.1213/01.ANE.0000130355.91214.9ECrossRef

21.

Khan RM, Maroof M, Hakim S, Jain D, Ashraf M (2004) Intraoperative stimulation of the P6 point controls postoperative nausea and vomiting following laparoscopic surgery. Can J Anesth/J Can Anesth 51(7):740–741. https://doi.org/10.1007/BF03018437CrossRef

22.

Streitberger K, Ezzo J, Schneider A (2006) Acupuncture for nausea and vomiting: an update of clinical and experimental studies. Autonom Neurosci 129(1):107–117. https://doi.org/10.1016/j.autneu.2006.07.015CrossRef

23.

Gao N, Chen H, Wang Y, Guo Y, Liu Z, Wang W (2022) Acupuncture to improve patient discomfort during upper gastrointestinal endoscopy: systematic review and meta-analysis. Front Med 9:865035. https://doi.org/10.3389/fmed.2022.865035CrossRef

24.

Hijikata T, Mihara T, Nakamura N, Miwa T, Ka K, Goto T (2016) Electrical stimulation of the heart 7 acupuncture site for preventing emergence agitation in children: a randomised controlled trial. Eur J Anaesthesiol 33(7):535–542. https://doi.org/10.1097/EJA.0000000000000379CrossRefPubMed

25.

Xu HY, Yang F, Zhu J, He ZP, Yan C (2007) Effect of electroacupuncture at Hegu (LI 4) and Sanyinjiao (SP 6) on short-term adverse effects of drug-induced abortion. Zhongguo Zhen Jiu 27(2):103–105PubMed

26.

Nakamura N, Mihara T, Hijikata T, Goto T, Ka K (2018) Unilateral electrical stimulation of the heart 7 acupuncture point to prevent emergence agitation in children: a prospective, double-blinded, randomized clinical trial. PLoS ONE 13(10):e0204533. https://doi.org/10.1371/journal.pone.0204533CrossRefPubMedPubMedCentral

27.

Beg S, Ragunath K, Wyman A, Banks M, Trudgill N, Pritchard DM, Riley S, Anderson J, Griffiths H, Bhandari P, Kaye P, Veitch A (2017) Quality standards in upper gastrointestinal endoscopy: a position statement of the British Society of Gastroenterology (BSG) and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS). Gut 66(11):1886–1899. https://doi.org/10.1136/gutjnl-2017-314109CrossRefPubMed

28.

Seip B, Huppertz-Hauss G, Sauar J, Bretthauer M, Hoff G (2008) Patients’ satisfaction: an important factor in quality control of gastroscopies. Scand J Gastroenterol 43(8):1004–1011. https://doi.org/10.1080/00365520801958592CrossRefPubMed

29.

Wang H, Xie Y, Zhang Q, Xu N, Zhong H, Dong H, Liu L, Jiang T, Wang Q, Xiong L (2014) Transcutaneous electric acupoint stimulation reduces intra-operative remifentanil consumption and alleviates postoperative side-effects in patients undergoing sinusotomy: a prospective, randomized, placebo-controlled trial. Br J Anaesth 112(6):1075–1082. https://doi.org/10.1093/bja/aeu001CrossRefPubMed

30.

Yu X, Zhang F, Chen B (2020) The effect of TEAS on the quality of early recovery in patients undergoing gynecological laparoscopic surgery: a prospective, randomized, placebo-controlled trial. Trials 21(1):43. https://doi.org/10.1186/s13063-019-3892-4CrossRefPubMedPubMedCentral

31.

Yao Y, Zhao Q, Gong C, Wu Y, Chen Y, Qiu L, Wu X, Chen Y (2015) Transcutaneous electrical acupoint stimulation improves the postoperative quality of recovery and analgesia after gynecological laparoscopic surgery: a randomized controlled trial. Evid-Based Complement Altern Med. https://doi.org/10.1155/2015/324360CrossRef

32.

Szmit M, Krajewski R, Rudnicki J, Agrawal S (2023) Application and efficacy of transcutaneous electrical acupoint stimulation (TEAS) in clinical practice: a systematic review. Adv Clin Exp Med 32(9):1063–1074. https://doi.org/10.17219/acem/159703CrossRefPubMed

33.

Albarracín D, Wyer RS (2000) The cognitive impact of past behavior: influences on beliefs, attitudes, and future behavioral decisions. J Pers Soc Psychol 79(1):5–22. https://doi.org/10.1037//0022-3514.79.1.5CrossRefPubMedPubMedCentral

Title: Transcutaneous electric nerve stimulation of acupuncture points improves tolerance in adults undergoing diagnostic upper gastrointestinal endoscopy: a single-center, double-blinded, randomized controlled trial
Authors: Jun Sen Chuah
Jih Huei Tan
Mohamad Adam Bujang
Koon Khee Chan
Nik Ritza Kosai
Publication date: 24-04-2024
Publisher: Springer US
Keywords: Acupuncture
Nerve Stimulation
Published in: Surgical Endoscopy
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-024-10841-8

At a glance: The STEP trials

Springer Medicine

Transcutaneous electric nerve stimulation of acupuncture points improves tolerance in adults undergoing diagnostic upper gastrointestinal endoscopy: a single-center, double-blinded, randomized controlled trial

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content