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February 2023, Volume 73, Issue 2

Research Article

Patients’ readiness before undergoing gastrointestinal endoscopy: A descriptive study

Authors: Tintin Sukartini  ( Department of Nursing, Airlangga University, East Java, Indonesia. )
Nursalam  ( Department of Nursing, Airlangga University, Surabaya, Indonesia. )
Erna Dwi Wahyuni  ( Department of Nursing, Airlangga University, Surabaya, Indonesia )
Ratri Ismiwiranti  ( Department of Endoscopy Unit, Regional Public Hospital, Situbondo, Indonesia. )
Sandeep Poddar  ( Lincoln University College, Petaling Jaya, Malaysia )


Objective: To analyse patients’ anxiety related to endoscopy.


Method: The descriptive study was conducted from July 23 to September 14, 2020, at the Endoscopy Unit of Dr Abdoer Rahem Situbondo General Region Hospital, Dr Koesnadi Bondowoso General Region Hospital and Ibnu Sina Gresik General Region Hospital, East Java, Indonesia. The sample comprised endoscopy patients of either gender aged >20 years. Data was collected using the Endoscopy Confidence Questionnaire.


Results: Of the 50 patients, 28(56%) were males and 22(44%) were females. The largest age group was 41-50 years 17(34%), followed by 31-40 years 13(26%). Overall, 48(96%) subjects were married. Abdominal pain was most common indication for the procedure 10(20%). Esophagogastroduodenoscopy was the procedure in 29(58%) patients, 42(84%) had no history of endoscopy, and 41(82%) were reluctant to undergo the procedure.


Conclusion: Patients’ anxiety rises before endoscopy. Nurses need to provide complete and clear information related to the procedure, including the less pleasant elements.


Keywords: Duodenoscopy, Anxiety, Gastritis, Readiness. (JPMA 73: S-92 [Suppl. 2]; 2023)






Diseases related to the gastrointestinal tract (GIT) require intensive treatment, but in certain circumstances the response to treatment is less than ideal. Endoscopic examination is one of the methods for detecting GIT diseases. It is one of the best options to identify abnormalities in the digestive tract correctly and clearly.1 However, endoscopic examination also has negative impacts on patients, one of which is anxiety which is related to endoscopic preparation, the procedure, the environment in which the patient is examined, and the results of the examination.2-5 Such anxiety may lead to delay in the procedure.

The negative effect felt by the patient indicates that the patient needs to be well prepared before undergoing an action procedure, like an endoscopic examination. The patient’s readiness to undergo an endoscopy procedure is influenced by several aspects, including the communication provided by health workers, the patient’s understanding of the procedure, the patient’s thoughts when imagining physical discomfort during endoscopic preparation, lack of privacy, anxiety about the results of the examination, and the possibility of complications and the illness itself.2,6-8

The patient’s readiness to undergo endoscopy will determine the success of the procedure.9 When the patient is ready to undergo the procedure, the patient can adapt to the procedure, so that the examination may proceed smoothly.10 The success of the procedure can increase patient satisfaction related to the services provided by a hospital, which can indirectly increase the patient’s enthusiasm to recover and the subsequent willingness to undergo other examinations.4,11,12 Considering the benefits and disadvantages, the patient’s readiness for endoscopy is very important.7 Thus, the nursing staff needs to identify the patient’s readiness before carrying out an endoscopic examination, as well as understand the fears of the individual13 to assess the overall readiness of the patient to undergo the procedure.14

The current study was planned to evaluate the anxiety experienced by endoscopy patients.


Material and Methods


The descriptive study was conducted from July 23 to September 14, 2020, at the Endoscopy Unit of Dr Abdoer Rahem Situbondo General Region Hospital, Dr Koesnadi Bondowoso General Region Hospital and Ibnu Sina Gresik General Region Hospital, East Java, Indonesia.

After approval from the ethics review committee of the Faculty of Nursing, Universitas Airlangga, the sample size was calculated using the Lemeshow formula.15 The sample was raised using purposive sampling technique. Those included were endoscopy patients of either gender aged >20 years who were able to communicate in Bahasha or any regional language that the researchers could understand. Patients with unstable haemodynamics, and those needing general anaesthesia were excluded.

Patients who were eligible for the study and met the criteria, were offered and explained about the study. The researcher was accompanied by the head of the endoscopy room to explain the research procedures to be carried out. After the patient agreed, then the patient was asked to sign an informed consent.

Data was collected using the Endoscopy Confidence Questionnaire (ECQ). Descriptive statistics were carried out to sort out the data.




Of the 50 patients, 28(56%) were males and 22(44%) were females. The largest age group was 41-50 years 17(34%), followed by 31-40 years 13(26%). Overall, 48(96%) subjects were married (Table 1).



Abdominal pain was most common indication for the procedure 10(20%). Esophagogastroduodenoscopy (EGD) was the procedure in 29(58%) patients, and 42(84%) had no history of endoscopy (Table 2). Overall, 41(82%) patients were reluctant to undergo the procedure (Table 3).






In the current study, the respondents who were ready to undergo endoscopy were aged 51-58 years, which is in line with previous research showing that patient readiness was supported by patient’s mental and emotional conditions in the age range that is more mature.16 There were 4 women patients who were ready to have endoscopy. This could be because women are considered stronger in facing health problems.17,18 The married patients were more likely to have endoscopy than the unmarried ones, which is in line with previous research.4,19 Patient willing to undergo the procedure tend to focus more on the benefits gained from the procedure and has good behavioural control to adapt to the less pleasant elements.20,21

Patients’ anxiety levels rise even before having endoscopy. Endoscopy consenting patients are typically frightened and worried. Lack of knowledge regarding the diagnostic technique or concerns about pain during the procedure may be the root of such fears. In fact, people may become anxious during an endoscopy and ultimately decide not to have one. Unfortunately, false ideas about the likelihood of discomfort, the danger of suffocation, or the escalation of legitimate worries about the possibility of infection transmission during endoscopy make patients fearful which exacerbates the anxiety level.5

Diagnostic procedures might become more uncomfortable and challenging when anxiety levels are high, leading to a rise in the use of sedatives and the difficulties that come with such an approach.4

A study showed that psychological preparation was effective in reducing anxiety.5 The nurse’s role in reducing patient anxiety when taking action is by providing education about the procedure by teaching deep breathing and distraction techniques.6 Anxiety can have negative consequences, such as increased pulse, respiration, blood pressure, even cancellation of the procedure. Therapeutic communication by the nurses may achieve optimal nursing goals so that the procedure may run smoothly.13

Nurses need to provide complete and clear information, including the less unpleasant elements22 as well as how the patients may adapt to these conditions.23 Nurses need to provide interventions to the patients, like hypnosis, audio, video, yoga and aromatherapy, that may improve decrease anxiety.24 Such interventions can improve a patient’s understanding of the action and lead to positive perception which, in turn, will increase  adaptive behaviour.25-30




Nurses need to provide complete and clear information related to endoscopic procedure, including the less pleasant elements, as well as how the patients can adapt to these conditions.

Limitation: This study only describes descriptively the level of stress in patients undergoing endoscopy. Further research is needed to find out the factors that can exacerbate stress and ways to relieve stress, so that patients can undergo endoscopy procedures comfortably. The number of patients involved in this study can be increased in future studies so that the results of the study can better describe the patient’s condition as a whole.


Acknowledgment: We are grateful to the Ministry of Education, Culture, Research and Technology, Indonesia.


Disclaimer: None.


Conflict of Interest: None.


Source of Funding: The Ministry of Education, Culture, Research and Technology, Indonesia.




1.      Mitchell M. Day surgery nurses’ selection of patient preoperative information. J Clin Nurs 2017;26:225-37. doi: 10.1111/jocn.13375.

2.      Abuksis G, Mor M, Segal N, Shemesh I, Morad I, Plaut S, et al. A patient education program is cost-effective for preventing failure of endoscopic procedures in a gastroenterology department. Am J Gastroenterol 2001;96:1786-90. doi: 10.1111/j.1572-0241.2001. 03872.x.

3.      Izanloo A, Fathi M, Izanloo S, Vosooghinia H, Hashemian A, Sadrzadeh SM, et al. Efficacy of Conversational Hypnosis and Propofol in Reducing Adverse Effects of Endoscopy. Anesth Pain Med 2015;5:e27695. doi: 10.5812/aapm.27695.

4.      Boustani H, Pakseresht S, Haghdoust MR, Qanbari S, Mehregan-Nasab H. Effect of psychological preparation on anxiety level before colonoscopy in outpatients referred to Golestan Hospital in Ahvaz. Front Biol 2017;12:235-9. Doi: 10.1007/s11515-017-1451-5.

5.      Behrouzian F, Sadrizadeh N, Nematpour S, Seyedian SS, Nassiryan M, Zadeh AJF. The Effect of Psychological Preparation on the Level of Anxiety before Upper Gastrointestinal Endoscopy. J Clin Diagn Res 2017;11:VC01-4. doi: 10.7860/JCDR/2017/24876.10270.

6.      Hsueh FC, Chen CM, Sun CA, Chou YC, Hsiao SM, Yang T. A Study on the Effects of a Health Education Intervention on Anxiety and Pain During Colonoscopy Procedures. J Nurs Res 2016;24:181-9. doi: 10.1097/jnr.0000000000000112.

7.      Shafer LA, Walker JR, Waldman C, Yang C, Michaud V, Bernstein CN, et al. Factors Associated with Anxiety About Colonoscopy: The Preparation, the Procedure, and the Anticipated Findings. Dig Dis Sci 2018;63:610-8. doi: 10.1007/s10620-018-4912-z.

8.      Pontone S, Tonda M, Brighi M, Florio M, Pironi D, Pontone P. Does anxiety or waiting time influence patients’ tolerance of upper endoscopy? Saudi J Gastroenterol 2015;21:111-5. doi: 10.4103/1319-3767.153839.

9.      Sukartini T, Nursalam N, Wahyuni ED, Ismiwiranti R. Psychological preparation model using hypnosis approach for patients before gastrointestinal endoscopy. Sys Rev Pharm 2020;11:1016-21.

10.    Miftahussurur M, Tandan M, Makmun D, Nabi Z. Peroral Endoscopic Myotomy in a Patient with Achalasia Cardia with Prior Heller’s Myotomy. Case Rep Gastroenterol 2020;14:48-55. doi: 10.1159/000505512.

11.    Beilenhoff U, Neumann CS. Quality assurance in endoscopy nursing. Best Pract Res Clin Gastroenterol 2011;25:371-85. doi: 10.1016/j.bpg. 2011.05.005.

12.    Griffiths B. Enhanced communication performance improvement and patient satisfaction in an endoscopy/ambulatory surgery unit. Gastroenterol Nurs 2015;38:194-200. doi: 10.1097/SGA. 0000000000000116.

13.    Toomey DP, Hackett-Brennan M, Corrigan G, Singh C, Nessim G, Balfe P. Effective communication enhances the patients’ endoscopy experience. Ir J Med Sci 2016;185:203-14. doi: 10.1007/s11845-015-1270-0.

14.    Sugihartono T, Miftahussurur M, Simamora RM, Kuntaman K, Rezkitha YAA, Yamaoka Y. Gastroesophageal Reflux Disease: Facts and Myths. J Int Dent Medical Res 2021;14:865-74.

15.    Lemeshow S, Hosmer DW Jr, Klar J, Lwanga SK. Adequacy of Sample Size in Health Studies. Chichester, UK: World Health Organization, John Wiley & Son Ltd, 1990; pp 1-5. [Online] 1990 [Cited 2022 September 27]. Available from URL: 39511442/Adequacy_of_Sample_Size_in_Health_Studies

16.    Werdani YDW. Effect of Mindfullness Meditation on Stress Level and Coping Mechanism in Cancer Patients. Folia Medica Indonesiana 2017;53:33-40.

17.    Ikhwan R. Women in health: Social practices in online health information management. Masy Kebud Pol 2020;33:371-80. Doi: 10.20473/mkp.V33I42020.371-380

18.    Karunia E. Relationship Between Family Support And Independence Activity Of Daily Living Posttroke. Jurnal Berkala Epidemiologi 2016;4:213-24.


19.    Mawaddah N, Paskarini I. The relationship between education, job satisfaction, and work motivation to work productivity (investigation on workers in the welding section of rack production at UD. King Rack, Surabaya, Indonesia). Indones J Public Heal 2021;16:404–15. doi: 10.20473/ijph.v16i3.2021.404-415

20.    Nursalam N, Irwindi YA, Nimah L, Efendi F. The Effect of Range of MotionExercise on Blood Pressure, Pulseand Sleep Quality amongHypertensive Patients. Int J Innov Creativity Chang 2020; 13:220–34.

21.    Kumar A, Shenoy V, Buckley MC, Durbin L, Mackey J, Mone A, et al. Endoscopic Disease Activity and Biologic Therapy Are Independent Predictors of Suboptimal Bowel Preparation in Patients with Inflammatory Bowel Disease Undergoing Colonoscopy. Dig Dis Sci 2022;67:4851-65. doi: 10.1007/s10620-022-07530-8.

22.    Arabul M, Kandemir A, Celik M, Torun S, Beyazit Y, Alper E, et al. Impact of video information before unsedated upper gastrointestinal endoscopy on patient satisfaction and anxiety: a prospective randomized trial. Prz Gastroenterol 2013;8:44-9. DOI: 10.5114/pg.2013.34182.

23.    Basir B, Awaludin S, Hidayat AI. Hypnotherapy and Yoga Combination Decrease the Anxiety ofPatients in Elective Preoperative. Jurnal Ner 2020;15:79-84. doi: 10.20473/jn.v15i1.1829.

24.    Kartika O, Sugihartono T, Kholili U, Karimah A, Nusi IA, Setiawan PB, et al. The effect of omeprazole administration to the quality of life of gastro esophageal reflux disease patients. New Armen Med J 2019;13:55-63.

25.    Hozumi H, Hasegawa S, Tsunenari T, Sanpei N, Arashina Y, Takahashi K, et al. Aromatherapies using Osmanthus fragrans oil and grapefruit oil are effective complementary treatments for anxious patients undergoing colonoscopy: A randomized controlled study. Complement Ther Med 2017;34:165-9. doi: 10.1016/j.ctim.2017.08.012.

26.    Leung FW. Methods of reducing discomfort during colonoscopy. Dig Dis Sci 2008;53:1462-7. doi: 10.1007/s10620-007-0025-9.

27.    Boselli E, Musellec H, Bernard F, Guillou N, Hugot P, Augris-Mathieu C, et al. Effects Of Conversational Hypnosis On Relative Parasympathetic Tone And Patient Comfort During Axillary Brachial Plexus Blocks For Ambulatory Upper Limb Surgery:A Quasiexperimental Pilot Study. Int J Clin Exp Hypn 2018;66:134-46. doi: 10.1080/00207144.2018.1421355

28.    Li L, Shu W, Li Z, Liu Q, Wang H, Feng B, et al. Yoga Nidra Recordings for Pain Management in Patients Undergoing Colonoscopy. Pain Manag Nurs 2019;20:39-46. doi: 10.1016/j.pmn.2018.04.005.

29.    Bundgaard K, Sørensen EE, Delmar C. TIME - MAKING THE BEST OF IT! A Fieldwork Study Outlining Time in Endoscopy Facilities for Short-Term Stay. Open Nurs J 2016;10:15-25. doi: 10.2174/1874434601610010015.

30.    Bundgaard K, Nielsen KB, Sørensen EE, Delmar C. The best way possible! A fieldwork study outlining expectations and needs for nursing of patientsin endoscopy facilitiesforshort-term stay. Scand J Caring Sci 2014;28:164-72. doi: 10.1111/scs.12032.

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