Doctors could catch cancers earlier without general anaesthetic or sedation

A new study has shown that mindfulness helps patients to relax during an endoscopy, allowing doctors to carry out detailed examinations without the need for sedation or general anaesthesia.

Researchers say mindfulness, combined with advanced endoscopy techniques and state-of-the-art digital technology, enables procedures to be done to a higher standard in awake patients than is currently possible under general anaesthesia or sedation. This means there is less chance of cancers being missed, with fewer associated complications, and less cost to the NHS.

In the study, published in the British Journal of Nursing, patients whose endoscopies were supported by mindfulness had higher satisfaction levels than had previously been reported by patients who’d been sedated.

The research suggests mindfulness could help the NHS cut waiting lists by moving some procedures out of operating theatres and sedation facilities and into outpatient clinics and community diagnostic centres, supporting the NHS elective recovery plan.

Professor Reza Nouraei performing an endoscopy on an awake patient using mindfulness techniques, including aura light projection, known locally as the ‘Bridgeford Borealis’.

A faster route to treatment

Ear Nose and Throat surgeons often perform partial examinations of the mouth, throat and voice box in outpatient clinics without sedation.

Full examinations are not typically available in outpatient clinics as they provoke strong coughing and gagging responses.

But now researchers have made it possible to fully examine the mouth, throat and voicebox in awake patients, and when necessary, the oesophagus and the stomach too, using mindfulness.

“A patient with a hoarse voice, throat problem or difficulty swallowing can walk into the clinic, have a more thorough examination in less than ten minutes than is possible in many cases under general anaesthesia, and walk out reassured,” says Professor Reza Nouraei, Professor of Laryngology and Clinical Informatics at the University of Southampton and a consultant Ear Nose and Throat Surgeon at the Loxley Centre for Airway, Voice and Swallowing at Queen’s Medical Centre, Nottingham.

“This one-stop approach means that most problems can be diagnosed with one appointment. For the small number of patients with cancer or other major problems, biopsies can often be taken there and then, and the road to treatment and recovery can begin straight away.

“Using mindfulness to support patients through these examinations is a large part of what makes them possible.”

Spotting cancers earlier

The mouth, throat, and voicebox are complex structures and it’s not usually possible to fully examine them in awake patients due to gag and cough reflexes, making general anaesthesia necessary for a complete assessment.

However, because of the risks and costs of general anaesthesia, only high-risk patients typically undergo such exams.

While this approach avoids unnecessary procedures, it can miss early cancers hidden in folded areas of the throat, especially in patients without obvious symptoms, leading to delayed diagnosis and treatment.

Using mindfulness

Researchers from the University of Southampton and Nottingham University Hospitals NHS Trust wanted to see if mindfulness could enable complete endoscopies to be routinely carried out in outpatient clinics.

They created a Mindful Endoscopy team at Queen’s Medical Centre in Nottingham to guide patients through the procedure using a range of mindfulness practices involving breathing, relaxation, communication techniques and positive imagery.

Prof Nouraei added: “These mindfulness techniques give the patient a sense of control in what could otherwise be a disempowering situation, which helps to regulate emotions and reduces the mental space available to catastrophising thoughts.

“Mindfulness also has a range of very specific effects that create a sense of calm at a physiological level. These range from lowering the heart rate and blood pressure, through to dissipating coughing and gagging before they can take hold and cause discomfort.”

In this study, Mindful Endoscopies revealed 12 cancer diagnoses - five per cent, which is a typical cancer diagnosis rate. At an average of 12 months after the endoscopy, no cancers had been missed.

Of the 231 patients who had endoscopies with the team, 92 per cent were satisfied or very satisfied with their experience.

That compares favourably with findings from a 2019 study which found a 53 per cent satisfaction rate for patients who’d had conventional aerodigestive endoscopies while awake, and an 86 per cent satisfaction rate for patients who’d been sedated.

Moving diagnosis closer to home

Improving examinations to help detect cancers earlier is especially important given the 2024 NHJS investigation findings that, aside from lung cancer, the NHS has made little progress in early cancer detection.

Mindful Endoscopy could also be readily delivered in community diagnostic centres, moving diagnostic care closer to home.

Prof Nouraei added: “This study demonstrates just one way in which mindfulness can be incorporated into a procedure to improve patients’ experience and use NHS resources more effectively.

“For the past 18 months in Nottingham, we have been using perioperative mindfulness to offer interventions to up to 22 patients with airway and voice problems in a single operating list. Before, when the same procedures used to need general anaesthesia, we could only operate on six to seven patients per day.

“We believe perioperative mindfulness could not only make a decisive difference in early cancer detection but also free up operating theatres and reduce waiting lists for many other procedures. We hope that this approach could be applied in different clinical settings, and across different procedures.”

Mindful endoscopy: holistically supporting patients through awake examinations of the path of swallowing is published in the British Journal of Nursing and is available online.

This work was supported, at its inception, by the Robert White Legacy Fund, Southampton University. For its implementation the work was supported by the East Midlands Cancer Alliance.