Randomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barrett's esophagus - 21/04/12
, 1, Elizabeth L. Bird-Lieberman, MB BChir, MRCP, PhD , 1, Maria O'Donovan, MB, MD, PRCPath 2, Zarah Abdullahi, BSc 1, Xinxue Liu, MD, PhD 1, Jane Blazeby, BSc, MB BChir, MD, FRCS, MSc 3, Rebecca Fitzgerald, MD 1, ⁎Reprint requests: Rebecca C. Fitzgerald, MD, MRC Cancer Cell Unit, Hutchison-MRC Research Centre, Hills Road, Cambridge, United Kingdom CB22 7QDRésumé |
Background |
Unsedated transnasal endoscopy (TNE) may be safer and less expensive than standard endoscopy (SE) for detecting Barrett's esophagus (BE). Emerging technologies require robust evaluation before routine use.
Objective |
To evaluate the sensitivity, specificity, and acceptability of TNE in diagnosing BE compared with those of SE.
Design |
Prospective, randomized, crossover study.
Setting |
Single, tertiary-care referral center.
Patients |
This study enrolled consecutive patients with BE or those referred for diagnostic assessment.
Intervention |
All patients underwent TNE followed by SE or the reverse. Spielberger State-Trait Anxiety Inventory short-form questionnaires, a visual analogue scale, and a single question addressing preference for endoscopy type were administered.
Main Outcome Measurements |
Diagnostic accuracy and tolerability of TNE were compared with those of SE.
Results |
Of 95 patients randomized, 82 completed the study. We correctly diagnosed 48 of 49 BE cases by TNE for endoscopic findings of columnar lined esophagus compared with the criterion standard, SE, giving a sensitivity and specificity of 0.98 and 1.00, respectively. The BE median length was 3 cm (interquartile range [IQR] 1-5 cm) with SE and 3 cm (IQR 2-4 cm) with TNE, giving high correlations between the two modalities (R2 = 0.97; P < .001). The sensitivity and specificity for detecting intestinal metaplasia by TNE compared with those by SE was 0.91 and 1.00, respectively. The mean (± standard deviation) post-endoscopy Spielberger State-Trait Anxiety Inventory short-form score for TNE (30.0 ± 1.10 standard error of the mean [SEM]) was lower than that for SE (30.7 ± 1.29 SEM), (P = .054). The visual analogue scale scores were no different (P = .07). The majority of patients (59%) expressed a preference for TNE.
Limitations |
This is a small study, with limited generalizability, a high prevalence of patients with BE, differential drop-out between the two procedures, and use of sedation.
Conclusion |
TNE is an accurate and well-tolerated method for diagnosing BE compared with SE. TNE warrants further evaluation as a screening tool for BE.
Le texte complet de cet article est disponible en PDF.Abbreviations : BE, CI, IM, SE, STAI, TNE
Plan
| DISCLOSURE: This study was supported by funding from the McCord Foundation (to R.F.), Cambridge Experimental Cancer Medicine Centre, NIHR Cambridge Biomedical Research Centre, and a core grant from the Medical Research Council. All funding was awarded to R.F. No other financial relationships relevant to this publication were disclosed. |
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| If you would like to chat with an author of this article, you may contact Dr Fitzgerald at rcf@hutchison-mrc.cam.ac.uk. |
Vol 75 - N° 5
P. 954-961 - mai 2012 Retour au numéro
Article précédent
- Feasibility, safety, acceptability, and yield of office-based, screening transnasal esophagoscopy (with video)
- Anne F. Peery, Toshitaka Hoppo, Katherine S. Garman, Evan S. Dellon, Norma Daugherty, Susan Bream, Alejandro F. Sanz, Jon Davison, Melissa Spacek, Diane Connors, Ashley L. Faulx, Amitabh Chak, James D. Luketich, Nicholas J. Shaheen, Blair A. Jobe, Barrett's Esophagus Risk Consortium
- Ultrathin transnasal endoscopy without sedation: the straight skinny
- Douglas G. Adler
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