Randomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barrett's esophagus.
BACKGROUND: Unsedated transnasal endoscopy (TNE) may be safer and less expensive than standard endoscopy (SE) for detecting Barrett's esophagus (BE). Emerging technologies require robust evaluation before routine use. OBJECTIVE: To evaluate the sensitivity, specificity, and acceptability of TNE...
| Egile Nagusiak: | , , , , , , |
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| Formatua: | Journal article |
| Hizkuntza: | English |
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2012
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| _version_ | 1826283471759212544 |
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| author | Shariff, M Bird-Lieberman, E O'Donovan, M Abdullahi, Z Liu, X Blazeby, J Fitzgerald, R |
| author_facet | Shariff, M Bird-Lieberman, E O'Donovan, M Abdullahi, Z Liu, X Blazeby, J Fitzgerald, R |
| author_sort | Shariff, M |
| collection | OXFORD |
| description | BACKGROUND: Unsedated transnasal endoscopy (TNE) may be safer and less expensive than standard endoscopy (SE) for detecting Barrett's esophagus (BE). Emerging technologies require robust evaluation before routine use. OBJECTIVE: To evaluate the sensitivity, specificity, and acceptability of TNE in diagnosing BE compared with those of SE. DESIGN: Prospective, randomized, crossover study. SETTING: Single, tertiary-care referral center. PATIENTS: This study enrolled consecutive patients with BE or those referred for diagnostic assessment. INTERVENTION: All patients underwent TNE followed by SE or the reverse. Spielberger State-Trait Anxiety Inventory short-form questionnaires, a visual analogue scale, and a single question addressing preference for endoscopy type were administered. MAIN OUTCOME MEASUREMENTS: Diagnostic accuracy and tolerability of TNE were compared with those of SE. RESULTS: Of 95 patients randomized, 82 completed the study. We correctly diagnosed 48 of 49 BE cases by TNE for endoscopic findings of columnar lined esophagus compared with the criterion standard, SE, giving a sensitivity and specificity of 0.98 and 1.00, respectively. The BE median length was 3 cm (interquartile range [IQR] 1-5 cm) with SE and 3 cm (IQR 2-4 cm) with TNE, giving high correlations between the two modalities (R(2) = 0.97; P < .001). The sensitivity and specificity for detecting intestinal metaplasia by TNE compared with those by SE was 0.91 and 1.00, respectively. The mean (± standard deviation) post-endoscopy Spielberger State-Trait Anxiety Inventory short-form score for TNE (30.0 ± 1.10 standard error of the mean [SEM]) was lower than that for SE (30.7 ± 1.29 SEM), (P = .054). The visual analogue scale scores were no different (P = .07). The majority of patients (59%) expressed a preference for TNE. LIMITATIONS: This is a small study, with limited generalizability, a high prevalence of patients with BE, differential drop-out between the two procedures, and use of sedation. CONCLUSION: TNE is an accurate and well-tolerated method for diagnosing BE compared with SE. TNE warrants further evaluation as a screening tool for BE. |
| first_indexed | 2024-03-07T00:59:24Z |
| format | Journal article |
| id | oxford-uuid:8933033c-3e33-4dfd-b92a-3dd5f8a09484 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T00:59:24Z |
| publishDate | 2012 |
| record_format | dspace |
| spelling | oxford-uuid:8933033c-3e33-4dfd-b92a-3dd5f8a094842022-03-26T22:22:50ZRandomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barrett's esophagus.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:8933033c-3e33-4dfd-b92a-3dd5f8a09484EnglishSymplectic Elements at Oxford2012Shariff, MBird-Lieberman, EO'Donovan, MAbdullahi, ZLiu, XBlazeby, JFitzgerald, RBACKGROUND: Unsedated transnasal endoscopy (TNE) may be safer and less expensive than standard endoscopy (SE) for detecting Barrett's esophagus (BE). Emerging technologies require robust evaluation before routine use. OBJECTIVE: To evaluate the sensitivity, specificity, and acceptability of TNE in diagnosing BE compared with those of SE. DESIGN: Prospective, randomized, crossover study. SETTING: Single, tertiary-care referral center. PATIENTS: This study enrolled consecutive patients with BE or those referred for diagnostic assessment. INTERVENTION: All patients underwent TNE followed by SE or the reverse. Spielberger State-Trait Anxiety Inventory short-form questionnaires, a visual analogue scale, and a single question addressing preference for endoscopy type were administered. MAIN OUTCOME MEASUREMENTS: Diagnostic accuracy and tolerability of TNE were compared with those of SE. RESULTS: Of 95 patients randomized, 82 completed the study. We correctly diagnosed 48 of 49 BE cases by TNE for endoscopic findings of columnar lined esophagus compared with the criterion standard, SE, giving a sensitivity and specificity of 0.98 and 1.00, respectively. The BE median length was 3 cm (interquartile range [IQR] 1-5 cm) with SE and 3 cm (IQR 2-4 cm) with TNE, giving high correlations between the two modalities (R(2) = 0.97; P < .001). The sensitivity and specificity for detecting intestinal metaplasia by TNE compared with those by SE was 0.91 and 1.00, respectively. The mean (± standard deviation) post-endoscopy Spielberger State-Trait Anxiety Inventory short-form score for TNE (30.0 ± 1.10 standard error of the mean [SEM]) was lower than that for SE (30.7 ± 1.29 SEM), (P = .054). The visual analogue scale scores were no different (P = .07). The majority of patients (59%) expressed a preference for TNE. LIMITATIONS: This is a small study, with limited generalizability, a high prevalence of patients with BE, differential drop-out between the two procedures, and use of sedation. CONCLUSION: TNE is an accurate and well-tolerated method for diagnosing BE compared with SE. TNE warrants further evaluation as a screening tool for BE. |
| spellingShingle | Shariff, M Bird-Lieberman, E O'Donovan, M Abdullahi, Z Liu, X Blazeby, J Fitzgerald, R Randomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barrett's esophagus. |
| title | Randomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barrett's esophagus. |
| title_full | Randomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barrett's esophagus. |
| title_fullStr | Randomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barrett's esophagus. |
| title_full_unstemmed | Randomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barrett's esophagus. |
| title_short | Randomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barrett's esophagus. |
| title_sort | randomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect barrett s esophagus |
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