The effect of virtual reality on pain,anxiety,and physiological parameters in patients undergoing gastroscopy

Abstract

Background

Patients undergoing gastroscopy may experience discomfort and heightened anxiety because they remain conscious throughout the procedure and may fear possible complications.

Objective

This study examined whether a virtual reality (VR)-based relaxation intervention influences pain intensity, anxiety levels, and physiological anxiety indicators in patients undergoing gastroscopy.

Methods

A randomized controlled, parallel-group design was used. The sample consisted of 78 patients, with 39 allocated to the VR intervention group and 39 to the control group. Patients in the intervention group viewed a five-minute relaxation program via VR goggles before and during the procedure, while the control group received standard care. Data were collected using the Patient Information Form, Visual Analog Scale-Pain (VAS-P), Visual Analog Scale-Anxiety (VAS-A), and Physiological Parameters of Anxiety Monitoring Form.

Results

Compared with the control group, patients receiving VR showed significantly lower post-intervention VAS-P and VAS-A scores, heart rate, systolic and diastolic blood pressure, and respiratory rate. Oxygen saturation levels were significantly higher (p < 0.05).

Conclusion

The VR relaxation intervention was associated with lower levels of pain, anxiety, and physiological stress responses, as well as higher oxygen saturation during gastroscopy. These findings suggest that VR applications may be considered as a supportive adjunct in gastroscopy nursing care to enhance patient comfort and safety.

Keywords

Gastroscopy upper gastrointestinal endoscopy virtual reality pain anxiety physiological parameters

Introduction

In contemporary medicine, endoscopic procedures are widely regarded as the gold standard for the diagnosis and treatment of gastrointestinal diseases due to their essential role in clinical practice. Among these procedures, upper gastrointestinal endoscopy (gastroscopy) is a minimally invasive technique that allows direct visualization of the esophagus, stomach, and duodenum using a flexible, camera-equipped instrument.¹ Despite its minimally invasive nature, gastroscopy is frequently associated with patient discomfort, including gagging, retching, choking sensations, and panic related to oropharyngeal stimulation. These experiences may lead to negative attitudes toward gastroscopy and adversely affect patient cooperation and procedural success.² To improve tolerability during gastroscopy, various supportive strategies are commonly used, including topical pharyngeal anesthesia, sedo-analgesia, and non-pharmacological interventions.^1,3 These experiences not only reduce physical comfort but also contribute to psychological stress and discomfort.⁴ Pain is not only a subjective experience but also brings about various physiological changes. For instance, a rise in heart rate and respiratory rate can result from an increase in myocardial oxygen demand induced by peripheral nervous system stimulation. The perception of pain causes an increase in the release of stress hormones, which in turn increases muscle tension. In muscles that remain constantly contracted, lactic acid builds up, triggering muscle fatigue.^5,6 In addition, the increased oxygen demand of muscle cells can pave the way for the development of muscle spasms.⁷ In addition to these physiological effects, the psychological processes experienced before gastroscopy are also extremely important for patients. Individuals may experience increasing anxiety in the period between deciding to undergo gastroscopy and the actual procedure. This anxiety may stem from a lack of information, previous negative experiences, or feelings of uncertainty about the procedure, and it may negatively affect patient satisfaction and cooperation with healthcare professionals in the pre-procedure period.⁸

Various approaches, such as sedation, anesthesia, and non-pharmacological interventions, are widely used during gastroscopy to increase patient comfort and minimize potential complications. Virtual reality (VR) applications have recently arisen as a viable non-pharmacological alternative to traditional pain and anxiety treatments, thanks to the increasing use of technology in healthcare.^9,10 VR technology provides an immersive 360-degree simulation environment that surrounds the user with both visual and auditory stimuli. This computer-assisted three-dimensional experience allows individuals to feel like active participants in a virtual environment, temporarily distancing themselves from reality. Compared to traditional distraction methods, the interactive and immersive nature of VR technology demonstrates higher effectiveness in diverting attention away from pain.¹¹ Furthermore, in today's world, where healthcare services are being reshaped with patient-centered approaches, personalizing medical experiences and increasing patient satisfaction are of great importance. In this context, VR applications provide significant advantages for modern individuals who are familiar with digital technologies and artificial intelligence, not only as effective distraction tools but also in terms of providing realistic, diverse, and user-friendly content.¹¹

Despite the fact that a number of studies have examined the use of VR during gastroscopy, the findings regarding pain and anxiety remain inconsistent. Moreover, relatively few studies have assessed physiological indicators of anxiety, limiting the generalizability of existing evidence. Therefore, the aim of this study was to examine the association between the use of a VR intervention and levels of pain, anxiety, and selected physiological parameters in patients undergoing gastroscopy.

Methods

Design

This investigation employed a parallel-group randomized controlled trial design and was registered at ClinicalTrials.gov (Identifier: NCT05585749).

Participants and setting

Participants were recruited from the gastroscopy unit of a university-affiliated hospital in Turkey between September 2022 and July 2023. Eligible individuals were adults aged 18 or older, capable of effective communication, and scheduled for non-sedated oral gastroduodenoscopy (OGD). No sedative or systemic pharmacological agents, including analgesics or antispasmodics (e.g. hyoscine butylbromide), were administered during the procedures, and supplemental oxygen was not provided. Routine topical pharyngeal anesthesia (lidocaine throat spray) was applied according to standard clinical practice when required. Exclusion criteria included emergency gastroscopy, neurological conditions (e.g. migraine, vertigo, and chronic headaches), or sensory impairments affecting hearing or vision. The gastroscopy unit was staffed by four gastroenterologists and four nurses, with two procedure rooms and one recovery room, performing approximately 20 procedures daily. The sample size was determined using a priori power analysis with G*Power version 3.1.9.4. Based on the data reported by Yılmaz and Dinçer,¹⁰ the effect size was calculated as 0.89. Considering an effect size of 0.89, a significance level of 0.05, and a power of 0.95, a minimum of 34 participants per group (68 in total) was required. During the study period, 202 candidates were assessed; 98 did not meet the eligibility criteria, and 26 declined participation, resulting in a final sample of 78 participants, with 39 allocated to each of the intervention and control groups. Randomization was performed using a list of numbers (1s and 2s) generated via Random.org by an independent researcher, ensuring unbiased group assignment. Throughout both the design and reporting phases of the trial, the principles of the Consolidated Standards of Reporting Trials (CONSORT) were followed. To enhance clarity of the study design, a CONSORT flow diagram illustrating participant enrollment, allocation, follow-up, and analysis has been presented in Figure 1. Blinding was not applied to participants or researchers conducting the intervention; however, statistical analyses were performed by a blinded analyst to minimize bias.

Figure 1.

Consolidated Standards of Reporting Trials (CONSORT) diagram.

Pilot study

A pilot study was conducted with 10 patients to test the feasibility of the application and the comprehensibility of the data collection tools before starting the research. The data obtained from this pilot study were not included in the main study group.

Measurements

Research data were collected through face-to-face interviews using the following tools: Patient Information Form, Visual Analog Scale-Anxiety (VAS-A), Visual Analog Scale-Pain (VAS-P), and the Physiological Parameters of Anxiety Monitoring Form.

Patient Information Form: This 13-item form collected demographic and clinical background information, including sex, age, marital status, income, education, chronic illnesses, and previous gastroscopy experience.

VAS-A: The VAS-A is a 10-cm horizontal line used for the subjective evaluation of anxiety. Participants mark their level of anxiety on the line, with 0 representing “no anxiety” and 10 representing “extreme anxiety.^12–14 Measurements were taken both before and after the gastroscopy procedure.

Physiological Parameters of Anxiety Monitoring Form: This form records objective physiological responses to anxiety, including systolic and diastolic blood pressure (mmHg), heart rate (beats per minute), respiratory rate (breaths per minute), and peripheral oxygen saturation (SpO₂, %).^13–16 Data were collected before and after the gastroscopy procedure using standardized methods.

VAS-P: Patients indicated their level of pain on a 10-cm horizontal line, with 0 representing “no pain” and 10 representing “unbearable pain.^14–17 Measurements were taken before and after the gastroscopy procedure.

Nursing interventions

Intervention group

In the intervention group, patients received VR intervention using VR Z4 Binocular Glasses (China) equipped with built-in headphones and motion sensors. A compatible smartphone was inserted into the device to provide a 360° immersive environment with head-tracking capability. The licensed VR content consisted of a 360° video of Benson's Progressive Muscle Relaxation Exercise, accompanied by nature scenes and relaxing background music.

Pre-test measurements (Patient Information Form, VAS-A, VAS-P, and Physiological Parameters of Anxiety Monitoring Form) were collected before the gastroscopy procedure. The VR relaxation video was initiated approximately 5 min prior to the procedure. VR glasses remained in place throughout the procedure and were removed immediately after the procedure was completed.

Pre-test measurements were collected before the gastroscopy procedure using the Patient Information Form, VAS-A, VAS-P, and Physiological Parameters of Anxiety Monitoring Form. The VR relaxation video was started approximately 5 min prior to the procedure.

VR glasses remained in place throughout the esophagogastroduodenoscopy (OGD) procedure and were removed immediately after its completion. The intervention was applied specifically during OGD, which allows safe placement of VR glasses without interfering with scope insertion, airway visualization, or patient monitoring. No supplemental oxygen was administered. The VR glasses were well tolerated by all participants, and no adverse events or safety concerns occurred.

Post-test measurements using the same forms were collected approximately 15–20 min after the gastroscopy procedure. No sham or placebo intervention was conducted.

Control group

Patients randomly assigned to the control group underwent initial (pre-test) measurements using the Patient Information Form, VAS-A, VAS-P, and the Physiological Parameters of Anxiety Monitoring Form before the gastroscopy procedure. No interventions were performed on the control group before or during the procedure; they received routine nursing care. Post-procedure measurements using the same forms were collected approximately 15–20 min after the gastroscopy procedure was completed.

Data evaluation

The statistical analysis was carried out using SPSS version 22.0. Descriptive statistics, including frequencies, means, and standard deviations, were used to summarize demographic data. Categorical data from distinct groups were analyzed using the chi-square test. Independent samples t-tests were used to compare the means between the two groups, while paired samples t-tests were used to evaluate changes within each group over time (e.g. pre- and post-gastroscopy). Skewness and kurtosis were reviewed to assess normality assumptions. Cohen's d was calculated to determine effect sizes, with the following interpretation: d < 0.2, small effect; 0.2 ≤ d < 0.8, moderate effect; d ≥ 0.8, large effect.¹⁸ A p-value <0.05 was considered statistically significant.

Ethical principles of the research

Prior to study initiation, written informed consent was obtained from all participants. In addition, verbal informed consent was also obtained to ensure participants’ full understanding of the study procedures. The requirement for written informed consent was not waived. Ethical approval was granted by the Fırat University Non-Interventional Research Ethics Committee (Approval No. 2022/04-22, date: 17 March 2022) and by the institution where the research was conducted. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. All participant data were kept strictly confidential and used solely for research purposes.

Results

The control and intervention groups were statistically equivalent in terms of baseline demographic and clinical characteristics prior to the gastroscopy procedure (Table 1).

Table 1.

Comparison of findings related to the descriptive characteristics of patients in the control and intervention groups (n = 78).

Variables		Groups
		Control		Intervention		Test value and significance
		N	%	N	(%)	Test value and significance
Gender	Female	19	48.7	17	43.6	χ² = 0.206, p = 0.650
Gender	Male	20	51.3	22	56.4	χ² = 0.206, p = 0.650
Marital status	Married	35	89.7	37	94.9	χ² = 0.722, p = 0.395
Marital status	Single	4	10.3	2	5.1	χ² = 0.722, p = 0.395
Educational status	Illiterate	1	2.6	2	5.1	χ² = 6.666, p = 0.247
	Literate	5	12.8	10	25.6
	Primary education	12	30.8	13	33.3
	Secondary education	8	20.5	2	5.1
	High school	5	12.8	7	17.9
	Bachelor's degree and above	8	20.5	5	12.8
Employment status	Employed	11	28.2	12	30.8	χ² = 0.062, p = 0.804
Employment status	Unemployed	28	71.8	27	69.1	χ² = 0.062, p = 0.804
Income status	Income covers expenses	16	41.0	14	35.9	χ² = 0.419, p = 0.811
	Income equals expenses	6	15.4	8	20.5
	Income is less than expenses	17	43.6	17	43.6
Chronic disease status	Yes	17	43.6	20	51.3	χ² = 0.463, p = 0.496
Chronic disease status	No	22	56.4	19	48.7	χ² = 0.463, p = 0.496
Previous endoscopy status	Yes	7	17.9	13	33.3	χ² = 2.421, p = 0.120
Previous endoscopy status	No	32	82.1	26	66.7	χ² = 2.421, p = 0.120
Continuous variables	X ± SD			X ± SD
Age mean	48.43 ± 13.88			51.71 ± 15.26		t = −0.993, p = 0.324

χ²: chi-square test; t: independent groups t-test.

At baseline (pre-gastroscopy), there were no significant differences between the intervention and control groups in VAS-P (2.51 ± 1.16 vs. 2.97 ± 2.03, t = −1.230, p = 0.223) or VAS-A scores (3.61 ± 1.44 vs. 3.71 ± 1.19, t = −0.342, p = 0.733). Similarly, no significant differences were observed between the groups in physiological parameters, including systolic blood pressure (135.12 ± 8.84 vs. 134.35 ± 9.94 mmHg, t = 0.361, p = 0.719), diastolic blood pressure (80.76 ± 8.70 vs. 79.48 ± 11.45 mmHg, t = –0.556, p = 0.580), heart rate (77.43 ± 5.60 vs. 77.82 ± 6.15 breaths/min, t = 0.223, p = 0.774), respiratory rate (20.97 ± 1.93 vs. 21.74 ± 2.96 breaths/min, t = −1.357, p = 0.179), and oxygen saturation (94.38 ± 2.28 vs. 94.17 ± 2.23%, t = 0.400, p = 0.690) (Tables 2 and 3).

Table 2.

Comparison of intra-group and inter-group mean VAS-Pain and VAS-Anxiety scores pre-gastroscopy and post-gastroscopy.

		Groups		Inter-group t^x/p
		Intervention (n = 39)	Control (n = 39)
		X ± SD	X ± SD
VAS-Pain	Before gastroscopy	2.51 ± 1.16	2.97 ± 2.03	t = −1.230, p = 0.223
VAS-Pain	After gastroscopy	1.64 ± 0.84	2.53 ± 1.42	t = –3.377, p = 0.001, d = 0.765
Intra-group t^y/p		t = 6.108, p = 0.001, d = 0.966	t = 1.665, p = 0.104
VAS-Anxiety	Before gastroscopy	3.61 ± 1.44	3.71 ± 1.19	t = −0.342, p = 0.733
VAS-Anxiety	After gastroscopy	1.71 ± 0.79	4.30 ± 1.71	t = −8.542, p = 0.000, d = 1.934
Intra-group t^y/p		t = 9.308, p = 0.000, d = 1.490	t = −1.744,p = 0.089

t^y: dependent groups t-test; t^x: independent groups t-test; d: Cohen’s d; *p < 0.05 is considered statistically significant.

Table 3.

Comparison of physiological anxiety parameters pre-gastroscopy and post-gastroscopy.

		Groups		Inter-group t^x/p
		Intervention (n = 39)	Control (n = 39)
		X ± SD	X ± SD
Systolic blood pressure	Before gastroscopy	135.12 ± 8.84	134.35 ± 9.94	t = 0.361, p = 0.719
Systolic blood pressure	After gastroscopy	124.61 ± 9.41	136.41 ± 15.12	t = −4.134, p = 0.000, d = 0.936
Intra-group t^y/p		t = −6.108, p = 0.000, d = 0.978	t = -0.796, p = 0.431
Diastolic blood pressure	Before gastroscopy	80.76 ± 8.70	79.48 ± 11.45	t = −0.556, p = 0.580
Diastolic blood pressure	After gastroscopy	72.56 ± 8.80	82.30 ± 10.87	t = −4.350, p = 0.000, d = 1.581
Intra-group t^y/p		t = 3.792, p = 0.000, d = 0.914	t = -1.992, p = 0.054
Heart rate	Before gastroscopy	77.43 ± 5.60	77.82 ± 6.15	t = 0.223, p = 0.774
Heart rate	After gastroscopy	74.84 ± 3.03	80.23 ± 4.28	t = −6.403, p = 0.000, d = 1.450
Intra-group t^y/p		t = 2.708, p = 0.010, d = 0.434	t = -2.009,p = 0.052
Respiratory rate	Before gastroscopy	20.97 ± 1.93	21.74 ± 2.96	t = −1.357, p = 0.179
Respiratory rate	After gastroscopy	19.58 ± 1.39	20.82 ± 2.66	t = −2.558, p = 0.013, d = 0.579
Intra-group t^y/p		t = 3.432, p = 0.001, d = 0.550	t = 1.666, p = 0.104
Oxygen saturation	Before gastroscopy	94.38 ± 2.28	94.17 ± 2.23	t = 0.400, p = 0.690
Oxygen saturation	After gastroscopy	95.84 ± 0.93	94.74 ± 2.11	t = 2.983, p = 0.004, d = 0.675
Intra-group t^y/p		t = -4.002, p = 0.000, d = 0.641	t = –2.434, p = 0.020, d = 0.390

t^y: dependent groups t-test; t^x: independent groups t-test; d: Cohen’s d; *p < 0.05 is considered statistically significant.

Post-gastroscopy, the intervention group showed significant reductions in VAS-P (1.64 ± 0.84, t = 6.108, p = 0.001, d = 0.966) and VAS-A scores (1.71 ± 0.79, t = 9.308, p < 0.001, d = 1.490), while the control group did not show significant intra-group changes (VAS-P: 2.53 ± 1.42, t = 1.665, p = 0.104; VAS-A: 4.30 ± 1.71, t = –1.744, p = 0.089). Between-group comparisons post-gastroscopy revealed significant differences favoring the intervention group for both VAS-P (t = –3.377, p = 0.001, d = 0.765) and VAS-A (t = –8.542, p < 0.001, d = 1.934) (Table 2).

Physiological parameters in the intervention group improved significantly post-gastroscopy, including systolic blood pressure (124.61 ± 9.41, t = –6.108, p < 0.001, d = 0.978), diastolic blood pressure (72.56 ± 8.80, t = 3.792, p < 0.001, d = 0.914), heart rate (74.84 ± 3.03, t = 2.708, p = 0.010, d = 0.434), respiratory rate (19.58 ± 1.39, t = 3.432, p = 0.001, d = 0.550), and oxygen saturation (95.84 ± 0.93, t = –4.002, p < 0.001, d = 0.641). In the control group, no significant intra-group changes were observed in systolic and diastolic blood pressure, heart rate, or respiratory rate, while oxygen saturation increased slightly (94.74 ± 2.11, t = –2.434, p = 0.020, d = 0.390). Post-gastroscopy between-group comparisons showed significant improvements favoring the intervention group for all physiological parameters (systolic blood pressure: t = –4.134, p < 0.001, d = 0.936; diastolic blood pressure: t = –4.350, p < 0.001, d = 1.581; heart rate: t = –6.403, p < 0.001, d = 1.450; respiratory rate: t = –2.558, p = 0.013, d = 0.579; oxygen saturation: t = 2.983, p = 0.004, d = 0.675) (Table 3).

Discussion

The findings of this study were evaluated in the context of the current literature. The similarity of demographic and clinical characteristics between the intervention and control groups indicates that baseline factors were unlikely to influence differences in pain, anxiety, or physiological outcomes.

This study demonstrated that VR significantly reduced pain levels in patients undergoing gastroscopy. This result is consistent with previous reviews and meta-analyses indicating that VR is an effective, non-invasive distraction tool for reducing procedure-related discomfort.¹¹ Çakır and Evirgen¹⁹ similarly highlighted that VR may reduce analgesic requirements and is practical and safe for nursing implementation. Various randomized controlled studies have also confirmed the pain-reducing effects of VR in different clinical procedures.^{10,13,16,17,20,21} VR's ability to visually and auditorily engage the patient is thought to decrease pain perception through immersive distraction, aligning with neurocognitive theories that shifting attention toward pleasant stimuli reduces perceived pain intensity.²² In line with the literature, our findings suggest that VR may be considered a useful non-pharmacological strategy to manage pain during gastroscopy.

The study also revealed that VR significantly reduced anxiety levels during gastroscopy. Similar findings were reported by Kim et al.,²³ who found that pre-procedural VR use decreased anxiety before endoscopy. VR has also been shown to reduce anxiety during sedation-free procedures such as upper endoscopy and bronchoscopy.^16,24 Several studies have confirmed VR's anxiolytic effects in a range of clinical settings,^{13,17,25–27} although a small number did not detect significant differences.^14,28 The theoretical basis for VR's anxiolytic impact is grounded in the redirection of attention away from stress-inducing stimuli and toward immersive, visually and auditorily engaging environments.²⁹ The results of this study reinforce existing evidence and support the use of VR as a feasible, non-invasive nursing intervention aimed at improving patient comfort and reducing anxiety during gastroscopy.

Additionally, VR use resulted in significant improvements in physiological parameters such as blood pressure, heart rate, respiratory rate, and oxygen saturation. These findings align with earlier studies indicating that VR can reduce physiological arousal by attenuating anxiety-related sympathetic activation.^13–17^,26 Taken together, these outcomes suggest that VR may be a beneficial adjunct in modulating physiological stress responses during gastroscopy.

Strengths and limitations of the study

This study has several strengths. It provides a multidimensional evaluation of the effects of VR by simultaneously examining psychological outcomes (pain and anxiety) and objective physiological parameters. The randomized controlled design and a priori sample size calculation enhance the methodological rigor of the study. In addition, the low cost, non-invasive nature, and ease of implementation of the VR intervention support its feasibility for integration into routine nursing practice. Reporting effect sizes alongside statistical significance further strengthens the interpretation of the clinical relevance of the findings.

A minor, non-significant increase in post-procedural VAS-A scores was observed in the control group, while VAS-P scores decreased slightly, but also without statistical significance. This indicates that undergoing gastroscopy without VR support may not effectively reduce anxiety, even when perceived pain shows a small decline. The discrepancy between slight pain reduction and increased anxiety underscores that pain and anxiety do not always change in parallel. These findings highlight the added value of VR intervention in simultaneously mitigating both anxiety and pain, emphasizing its potential as an effective non-pharmacological support during gastroscopy procedures.

Several limitations should also be acknowledged. First, the study was conducted in a single center with a specific patient population undergoing non-sedated gastroscopy, which may limit the generalizability of the results to other clinical settings or endoscopic procedures. Second, qualitative data reflecting patients’ subjective experiences, such as comfort, acceptability, and satisfaction, were not collected, limiting insight into how the intervention was perceived at an individual level. Third, neither participants nor researchers could be blinded due to the nature of the intervention; however, blinding during statistical analysis partially mitigated the risk of bias. In addition, the psychometric properties of single-item measures such as VAS-A and VAS-P were not examined in depth, which may affect the precision of subjective assessments.

Another important limitation is the absence of a sham-VR control condition. Without a sham-VR arm, it is not possible to fully distinguish the specific effects of immersive VR from non-specific factors such as expectancy effects, increased attention, novelty of the device, or enhanced staff–patient interaction. Consequently, the observed reductions in pain, anxiety, and physiological stress responses may have been partially influenced by these non-specific effects, potentially leading to an overestimation of the true intervention effect. Future randomized controlled trials incorporating a sham-VR condition (e.g. an inactive headset or non-immersive visual content) are warranted to more precisely isolate the specific therapeutic effects of VR and strengthen causal interpretations.

Future directions

Future research should incorporate qualitative assessments of patients’ subjective experiences, including comfort, acceptability, usability, and satisfaction with VR. Studies comparing VR use across different gastrointestinal endoscopic procedures (e.g. gastroscopy/OGD, transnasal endoscopy, and colonoscopy), evaluating different types of VR content (nature scenes, guided relaxation, and breathing exercises), and determining optimal exposure duration are recommended. Research examining the impact of VR on staff–patient communication, overall procedural satisfaction, workflow efficiency, and cost-effectiveness would further support clinical integration. Incorporating real-time patient-reported experiences during procedures could help clarify the clinical relevance and acceptability of VR interventions.

Conclusion

This study found that patients in the VR intervention group reported lower levels of anxiety and pain during gastroscopy, and were also associated with more favorable physiological indicators, including blood pressure, heart rate, respiratory rate, and oxygen saturation. These findings suggest that VR may be a feasible adjunct to enhance patient comfort during gastroscopy procedures.

Supplemental Material

sj-docx-1-dhj-10.1177_20552076261416801 - Supplemental material for The effect of virtual reality on pain, anxiety, and physiological parameters in patients undergoing gastroscopy

Supplemental material, sj-docx-1-dhj-10.1177_20552076261416801 for The effect of virtual reality on pain, anxiety, and physiological parameters in patients undergoing gastroscopy by Gülcan Bahçecioğlu Turan and Hatice Özdemir in DIGITAL HEALTH

Footnotes

Acknowledgements

This article is derived from the research project entitled “The Effect of Virtual Reality Application on Pain Intensity and Anxiety Levels in Patients Undergoing Endoscopy,” which was supported by the Scientific and Technological Research Council of Turkey (TÜBİTAK) under the 2209-A Research Project Support Programme for Undergraduate Students.

ORCID iD

Gülcan Bahçecioğlu Turan

Ethics approval and consent to participate

Prior to the study, written and verbal informed consent were obtained from all participants. Ethical approval for the study was granted by the Fırat University Non-Interventional Research Ethics Committee (Approval No. 2022/04-22, date: 17 March 2022), as well as by the institution where the research was conducted. The study adhered to the ethical principles of the Declaration of Helsinki. All participant data were kept strictly confidential and used solely for research purposes.

Consent for publication

Not applicable. This manuscript does not include identifying images or personal or clinical details of participants that compromise anonymity.

Authorship statement

All listed authors meet the authorship criteria, and all authors agree with the manuscript's content.

Clinical applications

VR technology may be considered for use in clinical practice to support patient comfort during invasive procedures, particularly in patients undergoing gastroscopy without sedation or with minimal sedation. Based on the findings of this study, VR applications may serve as a practical, non-invasive adjunct to standard care and may help reduce patient anxiety and discomfort, although further studies with sham-controlled designs are needed to confirm these effects and their impact on medication use.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by the Fırat University Scientific Research Projects Coordination Unit (FUBAP) within the scope of project number SYO.26.03

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

The data supporting this study's findings are available from the corresponding author upon reasonable request.

Supplemental material

Supplemental material for this article is available online.

References

Mahawongkajit

Soonthornkes

. Comparative effectiveness of lidocaine sprays between sitting and supine position for patients undergoing upper gastrointestinal endoscopy: a prospective randomized controlled trial. Surg Endosc 2022; 36: 5067–5075.

Sargin

Uluer

Aydogan

, et al. Anxiety levels in patients undergoing sedation for elective upper gastrointestinal endoscopy and colonoscopy. Med Arch 2016; 70: 112.

Martín-Marcos

Fernández-Morte

Balsategui-Martín

, et al. Evaluation of pharyngeal lidocaine anesthesia for esophagogastroduodenoscopy: double-blind randomized control trial. Dig Endosc 2022; 34: 808–815.

Ceyhan

Kartın

Taşcı

. Endoskopi eğitiminin hastalardaki kaygı düzeyine etkisi. Pam Med J 2018; 11: 293–300.

Fernandez Rojas

Brown

Waddington

, et al. A systematic review of neurophysiological sensing for the assessment of acute pain. npj Dig Med 2023; 6: 76.

Hall

. Guyton and Hall textbook of medical physiology, Jordanian edition e-book. Philadelphia, PA, USA: Elsevier Health Sciences, 2016.

Reynolds

Minic

. Chronic pain-associated cardiovascular disease: the role of sympathetic nerve activity. Int J Mol Sci 2023; 24: 5378.

Uluer

Sargın

. Endoskopi uygulanacak hastalardaki anksiyete düzeyinin sedasyon isteği üzerine etkisi. Avrasya Sağlık Bilimleri Dergisi 2019; 2: 15–19.

Ding

Hua

Zhu

, et al. Effects of virtual reality on relieving postoperative pain in surgical patients: a systematic review and meta-analysis. Int J Surg 2020; 82: 87–94.

10.

Yılmaz

Dinçer

NÜ

. The effects of virtual reality glasses on vital signs and anxiety in patients undergoing colonoscopy: a randomized controlled trial. Gastroenterol Nurs 2023; 46: 318–328.

11.

Yao

Qiu

Xue

, et al. Effects of virtual reality on relieving pain during endoscopy in adults: a systematic review and meta-analysis of randomised clinical trials. J Clin Nurs 2025; 34: 332–344.

12.

Şahin

. Korku, kaygi ve kaygi (anksiyete) bozukluklari. Avrasya Sosyal ve Ekonomi Araştırmaları Dergisi 2019; 6: 117–135.

13.

Turan

Gür

Özer

, et al. Effects of virtual reality on pain, anxiety, patient satisfaction in coronary angiography: a randomized trial. Pain Manag Nurs 2024; 25: e177–e185.

14.

Aslan

Özer

Yöntem

. Effect of virtual reality on pain, anxiety, and vital signs in endoscopy. Pain Manag Nurs 2025; 26: e371–e380.

15.

İnce

Özlü

. The effect of virtual reality on pain, anxiety, physiological parameters, and postspinal headache in patients undergoing spinal anesthesia: a randomized controlled trial. J Perianesth Nurs 2025; 40: 604–611.

16.

Sariköse

Turan

. The effects of virtual reality application on pain intensity, anxiety level and patient satisfaction in patients who undergo bronchoscopy: a randomized controlled trial. Pain Manag Nurs 2025; 26: 102–110.

17.

Menekli

Yaprak

Doğan

. The effect of virtual reality distraction intervention on pain, anxiety, and vital signs of oncology patients undergoing port catheter implantation: a randomized controlled study. Pain Manag Nurs 2022; 23: 585–590.

18.

Cohen

. Statistical power analysis for the behavioral sciences. New York, NY, USA: Routledge, 2013.

19.

Çakır

Evirgen

. The effect of virtual reality on pain and anxiety during colonoscopy: a randomized controlled trial. Turk J Gastroenterol 2021; 32: 451.

20.

Genç

Korkmaz

Akkurt

. The effect of virtual reality glasses and stress balls on pain and vital findings during transrectal prostate biopsy: a randomized controlled trial. J Perianesth Nurs 2022; 37: 344–350.

21.

Dutucu

Özdilek

Bektaş

. Sanal gerçekliğin mamografi sırasındaki ağrı ve anksiyeteye etkisi: randomize kontrollü bir çalışma. Anatolian J Health Res 2022; 3: 1–7.

22.

Colloca

Raghuraman

Wang

, et al. Virtual reality: physiological and behavioral mechanisms to increase individual pain tolerance limits. Pain 2020; 161: 2010–2021.

23.

Kim

Yoo

Chun

, et al. Relieving anxiety through virtual reality prior to endoscopic procedures. Yonsei Med J 2023; 64: 117.

24.

Ös

Ursavaş

. Determination of the effect of virtual reality on pain and anxiety in patients undergoing upper endoscopy: a randomized controlled trial. Gastroenterol Nurs 2025; 48: 299–306.

25.

Aldobekhi

. Efficacy of virtual reality as a treatment modality on preoperative vs postoperative patient anxiety: a systematic review. J Pharm Bioallied Sci 2024; 16: S3827–S3830.

26.

Sahin

Basak

. The effects of intraoperative progressive muscle relaxation and virtual reality application on anxiety, vital signs, and satisfaction: a randomized controlled trial. J Perianesth Nurs 2020; 35: 269–276.

27.

Yang

J-H

Ryu

Nam

, et al. Effects of preoperative virtual reality magnetic resonance imaging on preoperative anxiety in patients undergoing arthroscopic knee surgery: a randomized controlled study. Arthrosc: J Arthrosc Relat Surg 2019; 35: 2394–2399.

28.

Martinez-Bernal

Vidovich

Keenan

, et al. The use of virtual reality to reduce pain and anxiety in surgical procedures of the oral cavity: a scoping review. J Oral Maxillofac Surg 2023; 81: 467–482.

29.

Koo

C-H

Park

J-W

Ryu

J-H

, et al. The effect of virtual reality on preoperative anxiety: a meta-analysis of randomized controlled trials. J Clin Med 2020; 9: 3151.

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