Gastroenterology Department, University of the State of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.
Laboratory of clinical research on STD/AIDS, Evandro Chagas National Institute of Infectious Disease (INI) - Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.
Liver Int. 2018 Aug;38(8):1418-1426. doi: 10.1111/liv.13692. Epub 2018 Feb 10.
BACKGROUND & AIMS: Unsedated transnasal endoscopy may be used for detecting oesophageal varices. However, few studies evaluated feasibility and accuracy of this technique. We aimed to evaluate accuracy, interobserver agreement and safety of the transnasal ultrathin compared to conventional endoscopy in patients with cirrhosis.
This cross-sectional study included consecutive patients referred for screening or surveillance of oesophageal varices. Patients underwent unsedated transnasal and sedated conventional endoscopies at the same day, which were recorded in a digital video file and randomly analysed by two double-blinded endoscopists. High-risk varices were defined by the presence of large calibre or red wale marks. Accuracy, interobserver agreement and safety of transnasal were compared to conventional endoscopy.
One hundred and thirty-three cirrhotic patients (48% male, aged of 60 ± 5, 34% Child-Pugh B/C and 71% of cases for variceal screening) were included in the study. The prevalence of oesophageal varices and high-risk oesophageal varices were 59% (n = 79) and 29% (n = 39) respectively. For the presence of oesophageal varices, transnasal GIE yielded sensitivity of 94% [95% Confidence Interval, CI 88-99], specificity of 89% [81-97] as well as positive and negative predictive value of 93% and 91% respectively. A satisfactory interobserver agreement was observed for the presence of oesophageal varices (κ = 0.89) and high-risk varices (κ = 0.65). No serious adverse events were recorded; transnasal GIE was safe and significantly associated with lower rates of hypoxaemia (P < .0001) and hypotension (P < .0001) compared to conventional endoscopy.
Unsedated transnasal endoscopy was safe and had an excellent accuracy and high interobserver agreement for detecting oesophageal varices and for identifying high-risk varices in cirrhotic patients.
经鼻非镇静内镜检查可用于检测食管静脉曲张。然而，很少有研究评估该技术的可行性和准确性。我们旨在评估经鼻超细内镜与常规内镜在肝硬化患者中的准确性、观察者间一致性和安全性。
本横断面研究纳入了连续就诊进行食管静脉曲张筛查或监测的患者。患者于同一天接受经鼻非镇静和镇静常规内镜检查，将检查过程录制在数字视频文件中，并由两名双盲内镜医生随机分析。高危静脉曲张定义为存在大口径或红色波纹标记。将经鼻内镜的准确性、观察者间一致性和安全性与常规内镜进行比较。
本研究共纳入 133 例肝硬化患者（48%为男性，年龄 60±5 岁，34%为 Child-Pugh B/C 级，71%为静脉曲张筛查）。食管静脉曲张和高危食管静脉曲张的患病率分别为 59%（n=79）和 29%（n=39）。对于食管静脉曲张的存在，经鼻 GIE 的敏感度为 94%[95%置信区间，88-99%]，特异度为 89%[81-97%]，阳性预测值和阴性预测值分别为 93%和 91%。观察者间对于食管静脉曲张和高危静脉曲张的存在具有良好的一致性（κ=0.89 和 κ=0.65）。未记录到严重不良事件；与常规内镜相比，经鼻 GIE 安全且显著降低低氧血症（P<.0001）和低血压（P<.0001）的发生率。
经鼻非镇静内镜检查在肝硬化患者中安全且具有出色的准确性和观察者间高度一致性，可用于检测食管静脉曲张和识别高危静脉曲张。
