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Abstract
Introduction Unsedated ultrathin endoscopy has been proposed as a cost-effective and accurate alternative to standard endoscopy (SE) in screening for oesophageal varices, Barrett’s oesophagus and upper GI neoplasia. However, reports on performance of this technique (both via the transnasal [TNE] and transoral [TOE] routes) are conflicting. We aimed to estimate the technical success rate, tolerability, acceptability and patients’ preference for TNE and TOE alone and in comparison to SE.
Methods A systematic review and meta-analysis was performed of all primary studies reporting the outcomes of interest. Electronic databases (Cochrane library, MEDLINE, EMBASE) were searched from 1980 to September 1st 2013. Articles not published in English language were excluded.
Detailed data on study characteristics and endoscopic procedures was extracted. Study quality was assessed using the Cochrane Collaboration’s tool for assessing risk of bias. Sources of heterogeneity were investigated using meta-regression and subgroup analysis.
Results 34 studies met the inclusion criteria with 6,659 patients in total. The pooled proportion of technical success rate was slightly lower for TNE (0.94; 95% confidence interval [CI]: 0.92, 0.96; 30 studies) compared to TOE (0.98; 95% CI: 0.96, 0.99; 16 studies). The difference in proportion of success for TNE compared to SE was -0.03 (95% CI: -0.13, -0.48; 18 studies), however, there was no significant difference in success rate between TNE <6 mm in diameter and SE (-0.14; 95% CI: -0.32, 0.05; 9 studies). Similarly, There was no significant difference between TOE and SE (0.03; 95% CI: -0.12, 0.17; 10 studies).
The standardised difference in mean tolerability scores was not significant for both TNE vs. SE (0.036; 95% CI: -0.435, 0.508; 11 studies) and TOE vs. SE (0.004; 95% CI: -0.417, 0.424; 7 studies). Proportion of patients willing to undergo the procedure again in future (acceptability) was high for both TNE and TOE (0.85; 95% CI: 0.79, 0.90; 16 studies and 0.89; 95% CI: 0.82, 0.93; 10 studies, respectively). The pooled difference in proportion of patients who preferred TNE over SE was 0.63 (95% CI: 0.50, 0.80; 10 studies) (figure below), while 0.38 preferred TOE over SE (95% CI: -0.04, 0.80; 3 studies).
Conclusion There is no difference between TOE and SE in terms of technical success rate and preference. Success rate of TNE <6 mm in diameter is equivalent to SE, but majority of patients prefer the former over the latter. Hence, TNE (<6 mm in diameter) should be the procedure of choice for screening. Modern disposable and portable TNE devices might be useful for screening in the community.
Disclosure of Interest S. Sami: None Declared, V. Subramanian: None Declared, J. Ortiz-Fernández-Sordo: None Declared, A.-H. Saeed: None Declared, S. Singh: None Declared, P. Iyer: None Declared, K. Ragunath Grant/research support from: Olympus (Keymed, UK) and Intromedic Ltd. (Seoul, South Korea).