Feasibility, safety, acceptability, and yield of office-based, screening transnasal esophagoscopy (with video)

doi:10.1016/j.gie.2012.01.021

Gastrointestinal Endoscopy

Volume 75, Issue 5, May 2012, Pages 945-953.e2

Presented at Digestive Disease Week, May 5-8, 2011, Chicago, Illinois (Gastrointest Endosc 2012;73:AB157).

https://doi.org/10.1016/j.gie.2012.01.021 Get rights and content

Background

Endoscopic screening for esophageal neoplasia can identify patients eligible for early intervention for precancerous lesions. Unsedated transnasal esophagoscopy may provide an efficient and accurate endoscopic assessment with fewer risks and less cost, compared with conventional upper endoscopy.

Objective

To assess the feasibility, safety, acceptability, and yield of unsedated transnasal esophagoscopy in a primary care population.

Design

Multicenter, prospective, cross-sectional study.

Setting

Two outpatient tertiary-care centers.

Patients

This study involved a general medical clinic population aged between 40 and 85 years.

Intervention

Unsedated, office-based transnasal esophagoscopy.

Main Outcome Measurements

Procedure yield; completeness of examination; procedure length; adverse events and complications; choking, gagging, pain, or anxiety during the examination; and overall tolerability.

Results

A total of 426 participants (mean [± standard deviation] age 55.8 ± 9.5 years; 43% male) enrolled in the study, and 422 (99%) completed the examination. Mean (± standard deviation) examination time was 3.7 ± 1.8 minutes. There were no serious adverse events, and 12 participants (2.8%) reported minor complications. Participants reported minimal choking, gagging, pain, or anxiety. The examination was well-tolerated by most participants. Overall, 38% of participants had an esophageal finding that changed management (34% erosive esophagitis, 4% Barrett's esophagus).

Limitations

Nonrandomized study, tertiary-care centers only, self-selected population with a large proportion reporting esophageal symptoms.

Conclusion

Unsedated transnasal esophagoscopy is a feasible, safe, and well-tolerated method to screen for esophageal disease in a primary care population. Endoscopic findings are common in this patient population.

Section snippets

Study design and participants

We performed a prospective, cross-sectional study of unsedated, office-based transnasal esophagoscopy in two outpatient centers between 2009 and 2010. Participants were recruited from the general medical clinic populations by using flyers and e-mail announcements. We included participants aged between 40 and 85 years, regardless of GERD symptomatology. We excluded those with histories of anti-reflux surgery, esophageal diverticula or varices, cirrhosis, head and neck or esophageal malignancy,

Results

A total of 426 participants were enrolled in the study. The mean (± SD) age was 55.8 ± 9.5 years, and 43% were male (Table 1). The mean (± SD) BMI was 28.0 ± 6.1. Other characteristics of the cohort are reported in Table 1.

The majority of participants (70%) reported reflux or heartburn symptoms. Almost a third (29%) reported excess mucus in the nose or throat, and a quarter reported (25%) hoarseness. Approximately a fifth of participants reported globus (20%), chronic throat clearing (20%),

Discussion

Our study demonstrates that unsedated transnasal esophagoscopy is both feasible and safe in a primary care population, achieving short procedure times, a high diagnostic yield, and minimal anxiety. Patients reported good acceptability and minimal discomfort. Male sex, heartburn symptoms, a hiatal hernia, and no use of proton pump inhibitors were predictors of erosive esophagitis in this patient population.

Our study is the largest reported experience with transnasal esophagoscopy in the United

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Citation Excerpt :
There was a difference in technical success of −6% (94% with MACE versus 100% with EGD). This initial experience compares with published data, suggesting a technical success of esophageal intubation of 99% with EGD (with the use sedation if required),13 96% to 99% with unsedated transnasal endoscopy,14,15 93.9% using the cytosponge,16 and 98% with a dedicated esophageal capsule.17 Once the capsule was swallowed, it was possible to control the capsule within the esophagus, as demonstrated by the median and mean esophageal transit times of 163 and 190 seconds, respectively.
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The MiroCam Navi capsule system was used to examine the upper GI tract in patients due to undergo a clinically indicated EGD. A total of 50 participants were enrolled: 34 had known pathology (17 BE, 17 esophageal varices [EV]) and 16 controls. Patients underwent the MACE procedure with the operator blinded to the indication and any previous endoscopic diagnoses. The subsequent EGD was performed by an endoscopist blinded to the MACE findings. Diagnostic yield, comfort, and patient preference between the 2 modalities were compared.
The mean age of the participants was 61 years, the male/female ratio was 2.1:1, the mean body mass index was 29.5 kg/m², and the average chest measurement was 105.3 cm. Forty-seven patients underwent both procedures; 3 patients were unable to swallow the capsule. With the use of the magnet, it was possible to hold the capsule within the esophagus for a mean duration of 190 seconds and up to a maximum of 634 seconds. A correct real-time MACE diagnosis was made in 11 of 15 patients with EV (sensitivity 73.3% [95% confidence interval (CI), 44.9%-92.2%] and specificity 100% [95% CI, 89.1%-100%]) and 15 of 16 patients with BE (sensitivity 93.8% [95% CI, 69.8%-99.8%] and specificity of 100% [95% CI, 88.8%-100%]). MACE was considered more comfortable than conventional endoscopy (P < .0001); the mean score was 9.2 for MACE compared with 6.7 for EGD when assessed on a 10-point scale. No MACE- or EGD-related adverse events occurred.
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: DISCLOSURE: A. Chak received research support from Olympus America and Vision Sciences. N. Shaheen received research funding from BARRX Medical, CSA Medical, and OncoScope. This study was funded in part with grants K23 DK066165 (B.A.J.), T32 DK 07634 (A.F.P.), and R21 DK076827 (B.A.J.) from the National Institutes of Health. Equipment for the trial was donated by Vision Sciences (Orangeburg, New York). No other financial relationships relevant to this publication were disclosed.

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Original articleClinical endoscopyFeasibility, safety, acceptability, and yield of office-based, screening transnasal esophagoscopy (with video)

Background

Objective

Design

Setting

Patients

Intervention

Main Outcome Measurements

Results

Limitations

Conclusion

Section snippets

Study design and participants

Results

Discussion

Gastrointest Endosc

Gastroenterology

Gastroenterology

Gastrointest Endosc

Am J Gastroenterol

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Hum Pathol

J Voice

Am J Gastroenterol

Gastrointest Endosc

Original article
Clinical endoscopy
Feasibility, safety, acceptability, and yield of office-based, screening transnasal esophagoscopy (with video)