The Effect of Diaphragmatic Breathing Exercises Before Gastroscopy on Anxiety, Fear, and Vital Signs

Gastroscopy is a widely used and gold-standard endoscopic procedure in the diagnosis and treatment of upper gastrointestinal tract diseases. It plays a significant role in the early diagnosis and treatment of these diseases by allowing direct visualization of the esophagus, stomach, and duodenum (Areia et al., 2025; Bazerbachi et al., 2023) . However, gastroscopy is often perceived by patients as an uncomfortable and frightening procedure; this perception can lead to anxiety in the pre-procedure period (Çelik et al., 2022; Hua et al., 2025) .

The literature reports that pre-gastroscopy anxiety is quite common. A large-sample study of 1242 patients undergoing upper gastrointestinal endoscopy indicated that 52.7% of patients experienced significant anxiety before the procedure ( Yarbaş et al., 2025). The same study showed that female gender and the presence of chronic diseases were associated with high anxiety levels; however, previous gastroscopy experience or knowledge about the procedure did not significantly reduce anxiety. Similarly, another study of individuals undergoing gastroscopy without sedation highlighted that patients had moderate state anxiety scores, and that procedural tolerance decreased as anxiety levels increased (Yang et al., 2024). These findings demonstrate that pre-gastroscopy anxiety is a common occurrence and directly impacts patient compliance and procedural quality.

Several factors contribute to anxiety in patients during the pre-gastroscopy period. Anxiety often stems from insufficient information about endoscopy, fear of the procedure, pain and discomfort, the development of complications, loss of control, or inadequate attention during the procedure ( Nasution , 2022, Helba 2024 ). A study by Farooq et al. reported a correlation between high pre-gastroscopy anxiety levels and the risk of panic and fear during the procedure ( Farooq et al., 2025). Another study indicated that patients assessed with a Visual Analog Scale (VAS) before endoscopy had fear levels above seven ( Khan et al., 2023). It is noted that anxiety and fear experienced by patients during the pre-gastroscopy preparation period prolong the procedure time and affect the anesthesia dose, leading to undesirable outcomes ( Liu 2025, Sargın 2020). Emotional responses such as anxiety and fear experienced during the pre-gastroscopy period negatively impact the patient's comfort during the procedure and cause a physiological stress response due to autonomic nervous system activation. Sympathetic responses such as tachycardia, hypertension, and increased respiratory rate, which develop in relation to anxiety, can lead to transient changes in vital signs (Karpuzcu et al. 2025 ) . Although gastroscopy is generally a safe procedure, a large proportion of complications occurring during and after the procedure are reported to be related to cardiopulmonary complications and sedation ( Waddingham et al., 2022). Therefore, the application of safe and non-invasive interventions that help reduce anxiety and fear and support the stabilization of vital signs in the pre-gastroscopy period is considered a critical requirement for patient safety ( Bisschops et al., 2025).

In recent years, there has been an increase in research on the effectiveness of non-pharmacological interventions in reducing anxiety before gastroscopy and other invasive procedures. The literature indicates that methods such as informational training, visual aids, music therapy, aromatherapy, and relaxation techniques have a positive impact on patient satisfaction ( Khan et al., 2023; Mohamed et al., 2025; Calderon Martinez et al., 2025). In this context, another non-pharmacological method that has a positive impact on patient outcomes before invasive procedures is breathing exercises. Breathing exercises are noteworthy due to their applicability, low cost, and low risk of side effects. It is emphasized that breathing exercises have a regulatory effect on the autonomic nervous system, positively influencing vital signs such as heart rate, blood pressure, and respiratory rate ( Garg et al., 2023; Herawati et al., 2023; Ismail et al., 2025).

Numerous studies in the literature have examined the effects of breathing exercises on anxiety in different clinical groups ( Gauthier , 2023; Bulut, 2023). Çoban's (2025) study on cancer survivors highlighted that breathing exercise training reduced fear of cancer recurrence and improved mental well-being. Aktaş's (2022) randomized controlled trial with bariatric surgery patients showed that the 4-7-8 breathing technique significantly reduced situational anxiety. Similarly, other studies in surgical patients report that breathing exercises reduce anxiety levels and positively affect sleep quality and the healing process (Bulut & Karabulut, 2023; Lu et al., 2022). These findings support the idea that breathing exercises are an effective intervention not only on psychological but also on physiological parameters.

Although high rates of anxiety are reported in patients before gastroscopy, it is emphasized that this issue is not sufficiently considered in clinical practice ( Hua et al., 2025). This situation necessitates the adoption of a holistic care approach and the strengthening of nursing interventions in the pre-gastroscopy period (Yang, 2025). Nurses, as healthcare professionals who interact most with patients in the pre-procedure period, have a key role in anxiety management. Breathing exercises are considered an effective method that can be easily integrated into nursing care, increases patient participation, and supports self-management ( Herawati et al., 2023). A literature review revealed that there are limited studies that address the effects of pre-gastroscopy breathing exercises on situational anxiety, vital signs, and fear variables together. The aim of this research is to examine the effect of pre-procedure breathing exercises on anxiety levels, fear, and vital signs in adult patients undergoing gastroscopy. The aim of this study is to contribute to evidence-based practices aimed at reducing anxiety and fear before gastroscopy, increasing patient compliance, and to provide a scientific basis for healthcare professionals regarding the integration of breathing exercises into clinical practice.

Inclusion criteria

• Adults aged 18 years or older.
• Scheduled to undergo diagnostic gastroscopy.
• Medically eligible for gastroscopy (ASA Physical Status < III or suitable according to the institution's sedation protocol).
• Able to read and understand the study information and questionnaires. Willing to provide written informed consent.

Exclusion criteria

• Cardiac, pulmonary, or other clinical conditions for which the attending physician considers breathing exercises inappropriate.
• Diagnosed anxiety disorder or psychotic disorder.
• Development of severe dizziness, syncope, severe dyspnea, chest pain, nausea, marked discomfort, or significant breathing irregularity during the breathing intervention.
• Withdrawal of consent or unwillingness to continue participation.
• Inability to complete the intervention because of unexpected changes in the timing of the gastroscopy procedure.