Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea.
Endoscopy. 2011 Aug;43(8):649-56. doi: 10.1055/s-0030-1256474. Epub 2011 Jun 9.
We aimed to evaluate the accuracy of transnasal small-caliber esophagogastroduodenoscopy (TNSC-EGD) compared with peroral conventional EGD (POC-EGD) for evaluating varices in unsedated patients with liver cirrhosis. The success rate, safety, endoscopist satisfaction, and patient tolerability of TNSC-EGD were also addressed.
One hundred patients with liver cirrhosis participated in this randomized crossover trial, and 84 subjects completed both procedures. Of the 84 patients, 28 had marked bleeding diathesis (platelet count ≤ 50000/mm (3) and/or prothrombin time ≥ 1.7 INR). Endoscopists and patients answered questionnaires using a 100-mm visual analog scale about, respectively, their satisfaction and their tolerance of the procedure.
The success rate of TNSC-EGD was comparable to that of POC-EGD (96% vs. 99%). Nasal mucosal hemorrhages induced by TNSC-EGD occurred in 5 patients (6%), but were easily controlled. Compared to the POC-EGD reference test, diagnostic accuracies of TNSC-EGD for detecting esophageal varices, gastric varices, and red color signs were 98%, 98%, and 96%, respectively. Concordance rates on grading esophageal varices and gastric varices were excellent at 93% (κ = 0.85) and 96% (κ = 0.87). Endoscopist satisfaction was not significantly different between TNSC-EGD and POC-EGD, whereas patient tolerance of TNSC-EGD was significantly greater than that of POC-EGD (79.0 ± 14.4 vs. 69.5 ± 16.1; P = 0.001).
TNSC-EGD without sedation was found to be feasible, safe, and accurate for evaluating esophageal varices, gastric varices, and red color signs in patients with cirrhosis - even in those with marked bleeding diathesis. Furthermore, it was significantly better tolerated by patients, without altering endoscopist satisfaction. Our findings indicate that TNSC-EGD without sedation might be viewed as a potential alternative to POC-EGD for evaluation of varices.
我们旨在评估经鼻小口径食管胃十二指肠镜（TNSC-EGD）与经口常规 EGD（POC-EGD）在评估未镇静肝硬化患者静脉曲张方面的准确性。还探讨了 TNSC-EGD 的成功率、安全性、内镜医师满意度和患者耐受性。
这项随机交叉试验纳入了 100 例肝硬化患者，其中 84 例完成了两种检查。在 84 例患者中，28 例有明显出血倾向（血小板计数≤50000/mm(3)和/或凝血酶原时间≥1.7 INR）。内镜医师和患者分别使用 100 毫米视觉模拟量表回答了关于他们对该程序的满意度和耐受性的问题。
TNSC-EGD 的成功率与 POC-EGD 相当（96% vs. 99%）。5 例（6%）患者出现经鼻黏膜出血，但易于控制。与 POC-EGD 参考测试相比，TNSC-EGD 检测食管静脉曲张、胃静脉曲张和红色征的诊断准确性分别为 98%、98%和 96%。食管静脉曲张和胃静脉曲张分级的一致性率非常高，分别为 93%（κ=0.85）和 96%（κ=0.87）。TNSC-EGD 与 POC-EGD 的内镜医师满意度无显著差异，而 TNSC-EGD 的患者耐受性明显优于 POC-EGD（79.0±14.4 vs. 69.5±16.1；P=0.001）。
在肝硬化患者中，不镇静的 TNSC-EGD 是一种可行、安全且准确的方法，可用于评估食管静脉曲张、胃静脉曲张和红色征，即使在有明显出血倾向的患者中也是如此。此外，患者的耐受性明显更好，而不会改变内镜医师的满意度。我们的研究结果表明，不镇静的 TNSC-EGD 可能被视为评估静脉曲张的 POC-EGD 的一种潜在替代方法。
