Effectiveness of Unsedated Transnasal Endoscopy With White-light, Flexible Spectral Imaging Color Enhancement, and Lugol Staining for Esophageal Cancer Screening in High-risk Patients

Arantes, Vitor; Albuquerque, Walton; Salles, José Maria Porcaro; Dias, Carlos Alberto Freitas; Alberti, Luiz Ronaldo; Kahaleh, Michel; Ferrari, Teresa Cristina Abreu; Coelho, Luiz Gonzaga Vaz

doi:10.1097/mcg.0b013e3182617fc1

Cited by 36 publications

(31 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Previous studies have shown that the use of oxymetazoline for pediatric nasendoscopy is effective, safe and allows an ease of performance and cooperation of the patients [24] . Although we prepared the patient with an assurance of a successful nasal intubation, we did not use simethicone routinely, a compound that has been used in several studies to improve visibility [25] . Regarding costs, in our country the cost for the E.G.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of transnasal endoscopy with a disposable esophagoscope compared to conventional endoscopy

Aedo

Zavala-González

Meixueiro-Daza

et al. 2014

WJGE

View full text Add to dashboard Cite

AIM:To assess feasibility of unsedated esophagoscopy using a small-caliber disposable transnasal esophagoscopy and to compare its accuracy with standard endoscopy. METHODS:We prospectively included subjects who were referred for upper endoscopy. All subjects underwent transnasal endoscopy with E.G. Scan™. The disposable probe has a 3.6 mm gauge and at its distal end there is a 6 mm optical capsule, with a viewing angle of 125°. Patients underwent conventional endoscopy after the completion of E.G. Scan™. We describe the findings detected by the E.G. Scan™ and calculate the diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value and Kappa index for esophageal diagnosis. RESULTS:A total of 96 patients (54 women), mean age of 50.12 years (14 to 79), were evaluated. In all cases we were able to perform esophagoscopy with E.G.Scan™. The average realization time was 5 min. A total of 58 alterations were detected in the esophagus, 49 gastric abnormalities and 13 duodenal abnormalities. We found that for esophageal varices, E.G. Scan™ has sensitivity, specificity and diagnostic accuracy of 95%, 97% and 97%, respectively. Kappa coefficients were 0.32 for hiatal hernia, 0.409 for erosive gastroesophageal reflux disease, 0.617 for Barrett's esophagus, and 0.909 for esophageal varices. CONCLUSION:Esophagoscopy with E.G. Scan™ is a well-tolerated, fast and safe procedure. It has an appropriate diagnostic accuracy for esophageal varices when compared with conventional endoscopy.

show abstract

Section: Discussionmentioning

confidence: 99%

Accuracy of transnasal endoscopy with a disposable esophagoscope compared to conventional endoscopy

Aedo

Zavala-González

Meixueiro-Daza

et al. 2014

WJGE

View full text Add to dashboard Cite

show abstract

“…There has been increasing focus recently on the use of TNE as a screening tool especially for BO and early gastric and oesophageal malignancies. It use is also increasing for screening patients with documented aerodigestive tract tumours for coexisting oesophageal squamous cell carcinomas (SCCs) 47 48…”

Section: Diagnostic Capabilitymentioning

confidence: 99%

Transnasal endoscopy: no gagging no panic!

Parker

Alexandridis

Plevris

et al. 2015

Frontline Gastroenterol

View full text Add to dashboard Cite

Background Transnasal endoscopy (TNE) is performed with an ultrathin scope via the nasal passages and is increasingly used. This review covers the technical characteristics, tolerability, safety and acceptability of TNE and also diagnostic accuracy, use as a screening tool and therapeutic applications. It includes practical advice from an ear, nose, throat (ENT) specialist to optimise TNE practice, identify ENT pathology and manage complications. Methods A Medline search was performed using the terms "transnasal", "ultrathin", "small calibre", "endoscopy", "EGD" to identify relevant literature. Results There is increasing evidence that TNE is better tolerated than standard endoscopy as measured using visual analogue scales, and the main area of discomfort is nasal during insertion of the TN endoscope, which seems remediable with adequate topical anaesthesia. The diagnostic yield has been found to be similar for detection of Barrett's oesophagus, gastric cancer and GORDassociated diseases. There are some potential issues regarding the accuracy of TNE in detecting small early gastric malignant lesions, especially those in the proximal stomach. TNE is feasible and safe in a primary care population and is ideal for screening for upper gastrointestinal pathology. It has an advantage as a diagnostic tool in the elderly and those with multiple comorbidities due to fewer adverse effects on the cardiovascular system. It has significant advantages for therapeutic procedures, especially negotiating upper oesophageal strictures and insertion of nasoenteric feeding tubes.Conclusions TNE is well tolerated and a valuable diagnostic tool. Further evidence is required to establish its accuracy for the diagnosis of early and small gastric malignancies. There is an emerging role for TNE in therapeutic endoscopy, which needs further study.

show abstract

“…Arantes et al performed a prospective study with 106 patients, assessing the role of TNE for detection of esophageal cancer in a high-risk population. The method had excellent diagnostic performance and was well tolerated by patients 11 . Although suction through the smaller working channel of the ultra-thin endoscope is more time-consuming than with standard gastroscopy, air insufflation is not different from routine EGD, therefore, our impression is that staging of varices is not impaired during TNE, an assumption supported by 2 studies 33 34 .…”

Section: Resultsmentioning

confidence: 99%

“…This scale classifies numerically the intensity of pain or discomfort using a line numbered from 0 – 10. At one end of the line ("0") "no pain or discomfort" is pointed out and, on the other end ("10"), is the "worst discomfort or pain" 11 . After the examination, an independent investigator asked each patient to indicate, using the VAS scale, the level of pain or discomfort experienced during the procedure.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Feasibility of transnasal endoscopy in screening for esophageal and gastric varices in patients with chronic liver disease

et al. 2017

View full text Add to dashboard Cite

Background and study aims Screening for esophageal and gastric varices is indicated for patients with portal hypertension or cirrhosis. Typically, conventional endoscopy is used; however, the need for sedation increases the costs and risks, especially in cirrhotic patients. Use of transnasal endoscopy with an ultrathin endoscope enables study of the upper gastrointestinal tract without the need for sedation. The objective of this study is to evaluate the feasibility of transnasal endoscopy in screening for esophageal and gastric varices in patients with chronic liver disease. Patients and methods This was a prospective study in which transnasal endoscopy was carried out in patients with cirrhosis or portal hypertension who had indications for screening of esophageal and gastric varices. The following variables were evaluated: demographical data, duration of procedure, patient tolerance and acceptance, adverse events (AEs), endoscopic findings and interobserver agreement related to portal hypertension alterations ( kappa index). Results A total of 50 patients entered the study. The most common cause of liver disease was chronic viral hepatitis (66 %). Among the cirrhotic patients, most of the patients were Child-Pugh A (74 %). In 5 patients (10 %), nasal intubation was not possible. Two patients (4 %) experienced minor epistaxis. Tolerance was excellent or good in 92 % according with a visual analogic scale. In 16 patients (32 %), esophageal varices were detected and in 2 patients (4 %) gastric varices were detected. The mean duration of the procedure was 7 minutes. Conclusions Transnasal endoscopy is feasible, effective and well tolerated for screening of esophageal and gastric varices in patients with chronic liver disease. It can be performed in outpatient clinics safely and without the use of sedation.

show abstract

Effectiveness of Unsedated Transnasal Endoscopy With White-light, Flexible Spectral Imaging Color Enhancement, and Lugol Staining for Esophageal Cancer Screening in High-risk Patients

Abstract: Unsedated TNE is a feasible, well accepted, and efficient diagnostic tool for the screening of ESCC. The elevated rate of esophageal neoplasia strengthens the recommendations to screen patients with HNSCC. The yields of WLE and FICE were similar for ESCC detection.

Cited by 36 publications

References 30 publications

Accuracy of transnasal endoscopy with a disposable esophagoscope compared to conventional endoscopy

Accuracy of transnasal endoscopy with a disposable esophagoscope compared to conventional endoscopy

Transnasal endoscopy: no gagging no panic!

Feasibility of transnasal endoscopy in screening for esophageal and gastric varices in patients with chronic liver disease

Contact Info

Product

Resources

About