Background Limited data are available regarding the best mechanism and timing for assessing patient satisfaction with endoscopy. Objective To identify factors related to patient satisfaction with ...endoscopy and to determine if satisfaction after the procedure correlates with measurements at a later date. Design A prospective cohort study. Setting Tertiary academic hospital. Patients Patients undergoing EGD, colonoscopy, or both. Interventions Patients received preprocedure and postprocedure questionnaires on the procedure day. A third questionnaire (telephone or mail) was administered at least 1 week later. Main Outcome Measurements Satisfaction scores. Results A total of 261 patients were studied (53% men). The mean age was 55 ± 14 years. A total of 226 patients (86.6%) were very satisfied with their endoscopy. Factors positively associated with satisfaction were as follow: doctor's personal manner (odds ratio OR 3.00 95% CI, 1.80-5.03), doctor's technical skills (OR 2.65 95% CI, 1.55-4.51), nurse's personal manner (OR 2.84 95% CI, 1.74-4.63), physical environment (OR 1.75 95% CI, 1.16–2.64), and more time with doctor discussing the procedure (OR 1.66 95% CI, 1.02–2.69). Higher levels of pain or discomfort were associated with less satisfaction (OR 0.57 95% CI, 0.36–0.90). A total of 141 of 261 patients (54%) were reached for follow-up (mean SD 39 ± 26 days). These patients were less satisfied (rating dropped mean 0.35 points, P = .03) than those questioned sooner after the procedure and recalled experiencing more pain (rating increased mean 0.44 points, P = 0.01). Limitation Single center. Conclusions This study identified several factors that impacted patient satisfaction. Most patients initially appeared very satisfied, perhaps because of residual sedation and the distinct setting of the surveys. However, patient satisfaction tended to decrease over time, possibly because of recall bias. Future studies with patient satisfaction may require assessment at a date further removed from their endoscopy.
Fanconi syndrome is a rare disease of generalized proximal tubule dysfunction which can be acquired secondary to certain medications, including tenofovir, a commonly used hepatitis B treatment. Signs ...and symptoms of ensuing renal wasting can be severe but vague, leading to potentially avoidable invasive investigations and delays in diagnosis. We present a case of a 62-year-old female with chronic hepatitis B on tenofovir treatment who was found to have subacute weakness, anorexia, and weight loss. She underwent extensive investigations including computed tomography (CT) imaging, bronchoscopy, upper and lower endoscopy, and psychiatric evaluation. Finally, persistent electrolyte derangements led to urine studies, which demonstrated acquired Fanconi syndrome secondary to tenofovir. After discontinuing tenofovir disoproxil fumarate and starting tenofovir alafenamide, her symptoms resolved and her renal function recovered. This case illustrates the importance of maintaining clinical suspicion for tenofovir-induced Fanconi syndrome, given the common use of tenofovir as first-line hepatitis B treatment and the availability of less nephrotoxic alternatives.
