Gastroscopy is used for diagnosis and monitoring of therapy in many diseases. In particular, it is a unique diagnostic tool in malignant diseases where early diagnosis is of vital importance. However, the nausea and vomiting which accompany this procedure alienates both physician and patient, with many patients refusing endoscopy and a resultant delay in diagnosis. The physician is also hampered by patient retching, which lengthens procedure time.
A number of methods of nausea and vomiting prevention have been tried to date, the most favoured of which is a sedative dose of midazolam. Although it does not have antiemetic properties, the decrease in oropharyngeal irritation indirectly reduces nausea and vomiting. However, even in minimal doses, midazolam carries the risk of hypersensitivity and respiratory depression and requires the presence of anesthesiologist throughout the procedure.
It has recently been said that, acupuncture is said to be very effective for prevention of nausea and vomiting, but there are few studies on the subject. Studies on the P6 (Neiguan) acupuncture point are the most interesting in this respect. This point is 2T sun away from the wrist fold, at middle line and 6 mm. deep between the tendons of m.palmaris longus and m.flexor carpi radialis. 1T is accepted as the width of the thumb (
1-
3).
In a previous study that was carried out in our clinic, acupuncture was found to be effective in prophylaxis of nausea and vomiting at gynecologic laparoscopic operation. Ease of performance and cost-effectiveness of the method supports acceptance of it as an alternative therapy by many authorities (
4).
A group of investigators studying acupuncture prior to induction in gynecologic laparoscopy, reported that this method significantly reduces nausea and vomiting (
5).
Dundee and Mc Millan found acupuncture application on the P6 (Neiguan) acupuncture point prevented postoperative nausea and vomiting (
6). At the same time, transcutaneous electrical nerve stimulation (TENS) applied to traditional Chinese acupuncture points is also accepted as acustimulation.
Acustimulation has been found at least and sometimes more effective than acupuncture in many instances and with a wide spectrum of conditions such as postoperative pain, morning nausea, cancer chemotherapy, motion sickness etc. (
7,
8). It was for this reason that Reliefband was created with the application of TENS technology, minimizing it to a wriststrop. An electric current is created by TENS tool and enters the selected part of the body (
8).
Fasiolaki et al. demonstrated that transcutaneus electrical nerve stimulation reduces the incidence of nausea and vomiting and can therefore be used as an alternative to drugs (
9).
Nausea and vomiting that cannot be prevented by antiemetics alone occurring after cancer chemotherapy was reported point by Dundee to improve when drugs were accompanied by acustimulation on the P6 (Neiguan) acupuncture point (
10). Saller demonstrated that TENS application to the P6 (Neiguan) acupuncture point increases the effect of metoclopropamide significantly in cisplatin chemotherapy (
11). Mc Millan reported that the addition of TENS at the P6 (Neiguan) acupuncture point to usage of ondansetron as an antiemetic significantly increases the antiemetic effect of the drug (
12).
This study found acustimulation by use of the Reliefband to be an adequate nausea and vomiting prophylactic, but from the point of patient view of satisfaction, midazolam was found to be a more effective therapy. Although midazolam was less effective than acustimulation for nausea and vomiting, patient satisfaction was higher due to its effect of transient amnesia.
In conclusion, acustimulation is a good alternative to drug therapy for nausea and vomiting due to its advantages of ease of application, absence of side-effects, cost-effectiveness and variety of use.
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