Digestive Diseases Centre, University Hospitals of Leicester NHS Trust, Leicester, UK.
National Institute for Health Research (NIHR) Biomedical Research Center in Gastrointestinal and Liver Diseases, Nottingham University Hospitals NHS Trust, Nottingham, Nottingham, UK.
BMJ Open. 2019 Dec 11;9(12):e030467. doi: 10.1136/bmjopen-2019-030467.
Screening in selected high risk populations for Barrett's oesophagus (BO) and oesophageal varices (OVs) has been proposed, but there are obstacles with conventional oesophagogastroduodenoscopy (C-OGD), including patient acceptability. Portable and disposable office-based transnasal endoscopy (TNE) is a feasible and accurate alternative to C-OGD that may have use in primary and secondary care. This article outlines a qualitative analysis of patient experiences of TNE and C-OGD in order to gain an insight into an acceptable delivery of an endoscopic screening service.
Purposeful sampling identified 23 participants who then underwent semi-structured interviews to determine their experiences of both procedures. Thematic analysis was conducted to derive meaning from their lived experiences.
A secondary care endoscopy unit, clinic room and interview room.
Patients referred for BO or OV surveillance and for endoscopy to investigate dyspepsia underwent unsedated TNE using the EG Scan II device followed by C-OGD with or without sedation (patient choice), as part of a clinical trial.
The themes that arose from our analysis were: inclusivity in one's own healthcare, comfort level and convenience, validity of the procedure and application to a screening population and a sense of altruism and reciprocity. Positive aspects of TNE included participant empowerment, reduced discomfort and avoidance of conscious sedation. Participants felt that if TNE screening was of proven efficacy it would be welcomed, though views on use in a community setting were mixed.
Most patients preferred TNE to unsedated C-OGD and the reasons they gave featured strongly in the emerging themes. Preferences between TNE and sedated C-OGD were more subtle, with equivalent comfort scores but merits and drawbacks of both being discussed. This information identifies opportunities and challenges in establishing an endoscopic screening service. ISRCTNregistry identifier: 70595405; Pre-results.
在选定的高危人群中筛查 Barrett 食管（BO）和食管静脉曲张（OVs）已经被提出，但常规食管胃十二指肠镜检查（C-OGD）存在障碍，包括患者的接受度。便携式和一次性的经鼻内镜检查（TNE）是 C-OGD 的一种可行且准确的替代方法，可能在初级和二级保健中具有应用价值。本文概述了对 TNE 和 C-OGD 患者体验的定性分析，以深入了解内镜筛查服务的可接受性。
有目的的抽样确定了 23 名参与者，然后对他们进行半结构化访谈，以确定他们对这两种程序的体验。主题分析用于从他们的生活经验中得出意义。
二级保健内镜单位、诊所和访谈室。
接受 BO 或 OV 监测以及因消化不良进行内镜检查的患者，在临床试验中接受了未镇静的 EG Scan II 设备进行 TNE，然后进行 C-OGD 检查，可选择镇静（患者选择）。
我们的分析产生了以下主题：在自己的医疗保健中具有包容性、舒适度和便利性、程序的有效性和在筛查人群中的应用以及利他主义和互惠意识。TNE 的积极方面包括增强患者的自主权、减少不适和避免清醒镇静。参与者认为，如果 TNE 筛查被证明有效，它将受到欢迎，尽管对在社区环境中使用的看法存在分歧。
大多数患者更喜欢 TNE 而不是未镇静的 C-OGD，他们给出的原因在新出现的主题中占主导地位。TNE 和镇静 C-OGD 之间的偏好更为微妙，舒适度评分相当，但讨论了两者的优点和缺点。这些信息确定了建立内镜筛查服务的机会和挑战。ISRCTN 注册标识符：70595405；预结果。
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