Darwin P, Zangara J, Heller T, Haluszka O, Laurin J
Dept. of Medicine, University of Maryland Medical System, Baltimore 21201, USA.
Endoscopy. 2000 Dec;32(12):971-3. doi: 10.1055/s-2000-9624.
Unsedated endoscopy with ultrathin endoscopes has been shown to be an alternative to conventional endoscopy. This technique would appear to be an ideal way to screen for varices, but there is scant data for unsedated endoscopy in patients with cirrhosis. The aims of this pilot study were to evaluate whether unsedated endoscopy can be used to screen for varices and to determine how well it is tolerated in patients with hepatic dysfunction.
We prospectively evaluated unsedated esophagoscopy in 15 patients with cirrhosis who were candidates for beta-adrenergic-antagonist therapy. Patients with cirrhosis without gastrointestinal bleeding or contraindications to beta-adrenergic-antagonist therapy gave consent to the procedure. The presence and size of varices and the procedure time were recorded. After the procedure, patient tolerance, as gauged by questionnaire and willingness to repeat, was assessed.
All patients tolerated the procedure without significant discomfort. The mean time of the procedure was 2 minutes. Esophageal varices were found in nine of 15 patients. Of these, one patient with Child-Pugh class C cirrhosis had large varices and was started on propranolol.
Unsedated esophagoscopy in patients with cirrhosis appears to be well tolerated. Given both potential safety and cost benefits over conventional endoscopy, this could be a useful method for screening for varices. A randomized trial comparing this method with standard endoscopy is warranted.
已证实使用超薄内镜进行非镇静内镜检查是传统内镜检查的一种替代方法。该技术似乎是筛查静脉曲张的理想方式，但关于肝硬化患者非镇静内镜检查的数据却很少。这项初步研究的目的是评估非镇静内镜检查能否用于筛查静脉曲张，并确定肝功能不全患者对其的耐受程度。
我们前瞻性地评估了15例适合接受β-肾上腺素能拮抗剂治疗的肝硬化患者的非镇静食管镜检查。无胃肠道出血或无β-肾上腺素能拮抗剂治疗禁忌证的肝硬化患者同意接受该检查。记录静脉曲张的存在情况、大小及检查时间。检查后，通过问卷调查和再次接受检查的意愿来评估患者的耐受性。
所有患者均耐受该检查，且无明显不适。检查的平均时间为2分钟。15例患者中有9例发现食管静脉曲张。其中，1例Child-Pugh C级肝硬化患者有大静脉曲张，开始服用普萘洛尔。
肝硬化患者的非镇静食管镜检查似乎耐受性良好。鉴于与传统内镜检查相比具有潜在的安全性和成本效益，这可能是一种筛查静脉曲张的有用方法。有必要进行一项将该方法与标准内镜检查进行比较的随机试验。
