Chak Amitabh, Alashkar Bronia M, Isenberg Gerard A, Chandar Apoorva K, Greer Katarina B, Hepner Ashley, Pulice Richard D, Vemana Srikrishna, Falck-Ytter Yngve, Faulx Ashley L
Department of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA; Digestive Health Institute, University Hospitals Case Medical Center, Cleveland, Ohio, USA; Department of Gastroenterology, Case Western Reserve University, Cleveland, Ohio, USA.
Department of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA.
Gastrointest Endosc. 2014 Nov;80(5):774-82. doi: 10.1016/j.gie.2014.04.034. Epub 2014 Jun 25.
EGD screening for Barrett's esophagus (BE) is costly, with insufficient evidence to support its effectiveness.
To compare acceptance and tolerability of 2 novel, office-based, endoscopic screening techniques done on nonsedated patients.
Randomized block study design with allocation concealment.
Outpatient clinic setting at a Veterans Affairs medical center.
A total of 184 veterans with or without GERD symptoms.
Transnasal esophagoscopy (TNE) or esophageal capsule esophagoscopy (ECE).
Acceptance and tolerability of TNE and ECE and effectiveness of BE screening.
Esophageal screening was accepted by 184 of 1210 (15.2%) veterans. The majority were men (96%) and African American (58%), with a mean (± standard deviation) age of 58.9 (± 8.1) years. Five TNE participants (5%) and 2 ECE participants (2%) refused the assigned procedure after randomization (P = .25). Eleven patients (12.6%) randomized to TNE crossed the minimal clinically important threshold for overall procedure tolerability, as opposed to no patients randomized to ECE (P = .001). Effectiveness of BE screening was not significantly different in both procedures (TNE vs ECE = 3.2% vs 5.4%; P = .47). Overall, BE was present in 8 of 75 white participants (10.6%) and in 0 of 107 African American participants (P < .001).
The general veteran population may not reflect the screening population for BE.
Despite a small proportion of veterans expressing interest in esophageal screening, both TNE and ECE were feasible in the outpatient clinic setting and were accepted by >95% of participants who did express an interest. Screening was effective only in white participants. Moderate differences in tolerability between TNE and ECE notwithstanding, cost considerations along with availability of equipment and trained personnel should guide the modality to be used for BE screening.
采用上消化道内镜检查（EGD）筛查巴雷特食管（BE）成本高昂，且缺乏足够证据支持其有效性。
比较两种新型的、基于门诊的、针对未镇静患者的内镜筛查技术的接受度和耐受性。
采用随机区组研究设计并实施分配隐藏。
一家退伍军人事务医疗中心的门诊诊所。
总共184名有或无胃食管反流病（GERD）症状的退伍军人。
经鼻食管镜检查（TNE）或食管胶囊内镜检查（ECE）。
TNE和ECE的接受度和耐受性以及BE筛查的有效性。
1210名退伍军人中有184名（15.2%）接受了食管筛查。大多数为男性（96%）且是非裔美国人（58%），平均（±标准差）年龄为58.9（±8.1）岁。5名TNE参与者（5%）和2名ECE参与者（2%）在随机分组后拒绝了指定的检查程序（P = 0.25）。随机分配至TNE组的11名患者（12.6%）越过了总体检查耐受性的最小临床重要阈值，而随机分配至ECE组的患者中无人越过该阈值（P = 0.001）。两种检查程序在BE筛查的有效性方面无显著差异（TNE组与ECE组分别为3.2%和5.4%；P = 0.47）。总体而言，75名白人参与者中有8名（10.6%）存在BE，而107名非裔美国参与者中无人存在BE（P < 0.001）。
一般退伍军人人群可能无法反映BE的筛查人群。
尽管只有一小部分退伍军人对食管筛查感兴趣，但TNE和ECE在门诊诊所环境中均可行，并且95%以上表达兴趣的参与者接受了检查。筛查仅在白人参与者中有效。尽管TNE和ECE在耐受性方面存在适度差异，但成本因素以及设备和训练有素人员的可用性应指导用于BE筛查的方式选择。
