Jobe Blair A, Hunter John G, Chang Eugene Y, Kim Charles Y, Eisen Glenn M, Robinson Jedediah D, Diggs Brian S, O'Rourke Robert W, Rader Anne E, Schipper Paul, Sauer David A, Peters Jeffrey H, Lieberman David A, Morris Cynthia D
Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA.
Am J Gastroenterol. 2006 Dec;101(12):2693-703. doi: 10.1111/j.1572-0241.2006.00890.x.
A major limitation to screening and surveillance of Barrett's esophagus is the complexity, expense, and risk associated with sedation for upper endoscopy. This study examines the feasibility, accuracy, and patient acceptability of office-based unsedated endoscopy as an alternative.
Of 274 eligible adults scheduled for endoscopic screening for gastroesophageal reflux symptoms or surveillance of Barrett's esophagus at a tertiary care center, 121 underwent unsedated small-caliber endoscopy and conventional endoscopy in a randomized crossover study. The two procedures were compared with regard to histological detection of Barrett's esophagus and dysplasia and biopsy size. Patients answered questionnaires assessing the tolerability of the procedures.
The prevalence of Barrett's esophagus was 26% using conventional endoscopy and 30% using unsedated endoscopy (P= 0.503). The level of agreement between the two approaches was "moderate" (kappa= 0.591). Each modality detected four cases of low-grade dysplasia with concordance on one case. The tissue samples collected with unsedated endoscopy were smaller than with conventional endoscopy (P < 0.001). The majority of subjects rated their experience with both procedures as being well tolerated with minimal or no difficulty. When asked which procedure they would prefer in the future, 71% (81/114) chose unsedated small-caliber endoscopy.
Office-based unsedated small-caliber endoscopy is technically feasible, well tolerated, and accurate in screening for Barrett's esophagus, despite yielding a smaller biopsy specimen. This approach bears the potential to eliminate the infrastructure and cost required for intravenous sedation in this application.
巴雷特食管筛查和监测的一个主要限制是上消化道内镜检查镇静相关的复杂性、费用和风险。本研究探讨门诊非镇静内镜检查作为替代方法的可行性、准确性和患者可接受性。
在一家三级医疗中心，274名计划接受内镜筛查胃食管反流症状或巴雷特食管监测的符合条件的成年人中，121人在一项随机交叉研究中接受了非镇静小口径内镜检查和传统内镜检查。比较了两种检查方法在巴雷特食管和发育异常的组织学检测以及活检标本大小方面的差异。患者回答了评估检查耐受性的问卷。
使用传统内镜检查巴雷特食管的患病率为26%，使用非镇静内镜检查为30%（P = 0.503）。两种方法之间的一致性水平为“中等”（kappa = 0.591）。每种方法均检测到4例低级别发育异常，其中1例结果一致。非镇静内镜检查采集的组织样本比传统内镜检查的小（P < 0.001）。大多数受试者对两种检查的体验评价为耐受性良好，极少或没有困难。当被问及未来更喜欢哪种检查时，71%（81/114）选择了非镇静小口径内镜检查。
门诊非镇静小口径内镜检查在技术上可行，耐受性良好，在巴雷特食管筛查中准确，尽管活检标本较小。这种方法有可能消除该应用中静脉镇静所需的基础设施和成本。
