One‐hour fast for water and six‐hour fast for solids prior to endoscopy provides good endoscopic vision and results in minimum patient discomfort

Background and Aim: Current guidelines for upper gastrointestinal endoscopy (UGIE) advise at least 6–8 h fasting for solids and 4‐h fasting for liquids. We aimed to determine whether a 6‐h fast for solids and one‐hour fast for water prior to UGIE gives good endoscopic vision and less patient discomfort. Methods: 128 patients referred for UGIE were given a standard meal 6 h before endoscopy, and then randomized to either nil by mouth for 6 h (group A, n = 65) or allowed to drink water for up to one hour prior to endoscopy (group B, n = 63). Before endoscopy patients were requested to indicate discomfort due to fasting on a visual analog scale. Fluid in the gastric fundus was aspirated, when present, for volume and pH measurements, and endoscopic vision was graded. Results: 53 patients in group A and 43 patients in group B completed the study. Discomfort was significantly lower in group B than group A (P < 0.0001). Endoscopic vision was good in all 53 patients in group A and 40 in group B, and average in 3 patients in group B. Fluid in the gastric fundus was noted in 11 patients in group A and 16 in group B, but there were no significant differences in volume or pH between groups. There were no complications attributable to endoscopy in either group. Conclusions: A 6‐h fast for solids and a 1‐h fast for water prior to UGIE gives good endoscopic vision, and causes minimum patient discomfort.