de Faria Anderson Antônio, Dias Carlos Alberto Freitas, Dias Moetzsohn Luciana, de Castro Carvalho Silas, Ferrari Tereza Abreu, Nunes Arantes Vitor
Hospital das Clínicas, Federal University of Mimas Gerais, Alfa Institute of Gastroenterology, Belo Horizonte, Minas Gerais, Brazil.
Endosc Int Open. 2017 Jul;5(7):E646-E651. doi: 10.1055/s-0043-107781. Epub 2017 Jul 6.
Screening for esophageal and gastric varices is indicated for patients with portal hypertension or cirrhosis. Typically, conventional endoscopy is used; however, the need for sedation increases the costs and risks, especially in cirrhotic patients. Use of transnasal endoscopy with an ultrathin endoscope enables study of the upper gastrointestinal tract without the need for sedation. The objective of this study is to evaluate the feasibility of transnasal endoscopy in screening for esophageal and gastric varices in patients with chronic liver disease.
This was a prospective study in which transnasal endoscopy was carried out in patients with cirrhosis or portal hypertension who had indications for screening of esophageal and gastric varices. The following variables were evaluated: demographical data, duration of procedure, patient tolerance and acceptance, adverse events (AEs), endoscopic findings and interobserver agreement related to portal hypertension alterations ( index).
A total of 50 patients entered the study. The most common cause of liver disease was chronic viral hepatitis (66 %). Among the cirrhotic patients, most of the patients were Child-Pugh A (74 %). In 5 patients (10 %), nasal intubation was not possible. Two patients (4 %) experienced minor epistaxis. Tolerance was excellent or good in 92 % according with a visual analogic scale. In 16 patients (32 %), esophageal varices were detected and in 2 patients (4 %) gastric varices were detected. The mean duration of the procedure was 7 minutes.
Transnasal endoscopy is feasible, effective and well tolerated for screening of esophageal and gastric varices in patients with chronic liver disease. It can be performed in outpatient clinics safely and without the use of sedation.
对于门静脉高压或肝硬化患者，需进行食管和胃静脉曲张筛查。通常采用传统内镜检查；然而，镇静的需求增加了成本和风险，尤其是在肝硬化患者中。使用超薄鼻内镜进行经鼻内镜检查可在无需镇静的情况下对上消化道进行检查。本研究的目的是评估经鼻内镜检查在慢性肝病患者食管和胃静脉曲张筛查中的可行性。
这是一项前瞻性研究，对有食管和胃静脉曲张筛查指征的肝硬化或门静脉高压患者进行经鼻内镜检查。评估了以下变量：人口统计学数据、检查过程持续时间、患者耐受性和接受度、不良事件（AE）、内镜检查结果以及与门静脉高压改变相关的观察者间一致性（指数）。
共有50名患者进入研究。肝病最常见的病因是慢性病毒性肝炎（66%）。在肝硬化患者中，大多数患者为Child-Pugh A级（74%）。5名患者（10%）无法进行鼻腔插管。2名患者（4%）出现轻微鼻出血。根据视觉模拟评分，92%的患者耐受性良好或极佳。16名患者（32%）检测到食管静脉曲张，2名患者（4%）检测到胃静脉曲张。检查过程的平均持续时间为7分钟。
经鼻内镜检查在慢性肝病患者食管和胃静脉曲张筛查中是可行、有效且耐受性良好的。它可以在门诊安全地进行，无需使用镇静剂。
