Modified mallampati classification as a clinical predictor of peroral esophagogastroduodenoscopy tolerance

Hsin-Hung Huang, Meei-Shyuan Lee, Yu-Lueng Shih, Heng-Cheng Chu, Tien-Yu Huang, Tsai-Yuan Hsieh

Research output: Contribution to journalArticlepeer-review

26 Citations (Scopus)


Background: Unsedated esophagogastroduodenoscopy (EGD) is simpler and safer than sedated EGD; however, approximately 40% of patients cannot tolerate it. Early identification of patients likely to poorly tolerate unsedated EGD is valuable for improving compliance. The modified Mallampati classification (MMC) has been used to evaluate difficult tracheal intubation and laryngoscope insertion. We tried to assess the efficacy of MMC to predict the tolerance of EGD in unsedated patients.Methods: Two hundred patients who underwent an unsedated diagnostic EGD were recruited. They were stratified according to the view of the oropharynx as either MMC class I + II (good view) or class III + IV (poor view). EGD tolerance was assessed in three ways: gag reflex by endoscopist assessment, patient satisfaction by interview, and the degree of change in vital signs.Results: MMC was significantly correlated to gag reflex (P <0.001), patient satisfaction (P = 0.028), and a change of vital signs (P = 0.024). Patients in the poor view group had a 3.87-fold increased risk of gag reflex (P <0.001), a 1.78-fold increased risk of unsatisfaction (P = 0.067), and a 1.96-fold increased risk of a change in vital signs (P = 0.025) compared to those in the good view group.Conclusions: MMC appears to be a clinically useful predictor of EGD tolerance. Patients with poor view of oropharynx by MMC criteria may be candidates for sedated or transnasal EGD. © 2011 Huang et al; licensee BioMed Central Ltd.
Original languageEnglish
JournalBMC Gastroenterology
Publication statusPublished - 2011
Externally publishedYes


  • adult
  • age distribution
  • aged
  • anxiety
  • article
  • body mass
  • clinical trial
  • controlled clinical trial
  • controlled study
  • esophagogastroduodenoscopy
  • female
  • gastroesophageal reflux
  • human
  • interview
  • major clinical study
  • male
  • mean arterial pressure
  • medical specialist
  • modified mallampati classification
  • non invasive measurement
  • oropharynx
  • oxygen saturation
  • patient education
  • patient satisfaction
  • peptic ulcer
  • peroral esophagogastroduodenoscopy tolerance
  • physical tolerance
  • prediction
  • pulse rate
  • reliability
  • sensitivity and specificity
  • sex difference
  • smoking
  • adolescent
  • blood pressure
  • digestive tract endoscopy
  • evaluation
  • gastrointestinal symptom
  • glottis
  • heart rate
  • histology
  • middle aged
  • palate
  • physiology
  • predictive value
  • retrospective study
  • soft palate
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Pressure
  • Endoscopy, Digestive System
  • Female
  • Gagging
  • Gastroesophageal Reflux
  • Glottis
  • Heart Rate
  • Humans
  • Male
  • Middle Aged
  • Palate, Soft
  • Patient Satisfaction
  • Peptic Ulcer
  • Predictive Value of Tests
  • Retrospective Studies
  • Uvula
  • Young Adult


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