Shariff Mohammed K, Varghese Sibu, O'Donovan Maria, Abdullahi Zarah, Liu Xinxue, Fitzgerald Rebecca C, di Pietro Massimiliano
MRC Cancer Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom.
Endoscopy. 2016 Feb;48(2):110-6. doi: 10.1055/s-0034-1393310. Epub 2015 Nov 4.
The transnasal endosheath endoscope is a new disposable technology with potential applicability to the primary care setting. The aim of this study was to evaluate the efficacy of transnasal endosheath endoscopy (TEE) for the detection of Barrett's esophagus, by comparing the diagnostic accuracy of TEE with that of standard endoscopy.
This was a prospective, randomized, crossover study performed in a single tertiary referral center. Consecutive patients undergoing surveillance for Barrett's esophagus or referred for diagnostic assessment were recruited. All patients were randomized to undergo TEE followed by standard endoscopy or the reverse. Endoscopy experiences and patient preferences were evaluated using a questionnaire. Endoscopic and histologic diagnosis of Barrett's esophagus, and optical image quality of both endoscopic procedures, were compared.
A total of 21 of 25 patients completed the study. TEE had sensitivity and specificity of 100 % for an endoscopic diagnosis of Barrett's esophagus, and of 66.7 % and 100 %, respectively, for the histologic diagnosis of Barrett's esophagus. The mean optical quality of standard endoscopy was significantly better than that of TEE (7.11 ± 0.42 vs. 4.06 ± 0.27; P < 0.0001). However, following endoscopy, patients reported a significantly better experience with TEE compared with standard endoscopy (7.05 ± 0.49 vs. 4.35 ± 0.53; P = 0.0006), with 60 % preferring TEE and 25 % preferring sedated standard endoscopy.
In this study, TEE had equal accuracy for an endoscopic diagnosis of Barrett's esophagus compared with standard endoscopy, at the expense of reduced image quality and a lower yield of intestinal metaplasia on biopsy. TEE was better tolerated and preferred by patients. Hence, TEE needs further evaluation in primary care as an initial diagnostic tool.
经鼻鞘内内窥镜是一项新型一次性技术，在基层医疗环境中具有潜在的适用性。本研究的目的是通过比较经鼻鞘内内窥镜检查（TEE）与标准内窥镜检查的诊断准确性，评估TEE检测巴雷特食管的疗效。
这是一项在单一三级转诊中心进行的前瞻性、随机、交叉研究。招募了接受巴雷特食管监测或因诊断评估而转诊的连续患者。所有患者随机分为先接受TEE检查随后进行标准内窥镜检查，或顺序相反。通过问卷调查评估内窥镜检查体验和患者偏好。比较巴雷特食管的内窥镜和组织学诊断，以及两种内窥镜检查的光学图像质量。
25例患者中有21例完成了研究。TEE对巴雷特食管的内窥镜诊断敏感性和特异性均为100%，对巴雷特食管的组织学诊断敏感性和特异性分别为66.7%和100%。标准内窥镜检查的平均光学质量明显优于TEE（7.11±0.42对4.06±0.27；P<0.0001）。然而，内窥镜检查后，患者报告TEE的体验明显优于标准内窥镜检查（7.05±0.49对4.35±0.53；P=0.0006），60%的患者更喜欢TEE，25%的患者更喜欢镇静状态下的标准内窥镜检查。
在本研究中，与标准内窥镜检查相比，TEE对巴雷特食管的内窥镜诊断准确性相同，但代价是图像质量降低和活检时肠化生的检出率较低。TEE的耐受性更好，更受患者青睐。因此，TEE作为初始诊断工具在基层医疗中需要进一步评估。
