Office-Based Unsedated Ultrathin Esophagoscopy in a Primary Care Setting

Abstract

PURPOSE Gastroesophageal refl ux disease is common and with time may be complicated by Barrett's esophagus and esophageal adenocarcinoma. Upper gastrointestinal endoscopy, including esophagoscopy, is the procedure of choice to diagnose Barrett's esophagus and other esophageal disease. The use of unsedated ultrathin esophagoscopy (UUE) has been reported by gastroenterologists in specialized endoscopy units and otolaryngologists in outpatient otolaryngology offi ces, but UUE has not been previously described in a primary care setting. This study examines the feasibility of offi ce-based UUE in primary care. METHODSThis study is a retrospective chart review in a university-based family medicine clinic in the southeastern United States. Charts were reviewed of 56 adult outpatients who were referred for further evaluation of refl ux symptoms that persisted after at least 4 weeks of therapy with histamine 2 receptor agonists or proton pump inhibitors and who elected to undergo UUE in the primary care setting. Patient demographics, procedure indications and fi ndings, changes in clinical management, and procedure times were recorded. RESULTSOne hundred percent of patients asked to participate in UUE were willing to undergo the procedure (mean age 48.3 ± 1.6 y, 57.1% women); 95% of the patients tolerated UUE. Barrett's esophagus was diagnosed in 5.7% (n = 3) of the patients. Mean procedure time was 5.5 ± 1.7 min. No complications were reported in this series.CONCLUSIONS Initial data suggest that UUE is feasible in primary care, with the majority of patients tolerating the procedure. UUE may be an effi cient method of examining the distal esophagus. INTRODUCTIONG astroesophageal refl ux disease (GERD) is a chronic disease encountered in primary care and requires lifelong therapy in as many as 50% of patients. 1 Barrett' s esophagus is a complication of chronic GERD found in approximately 10% of patients undergoing upper gastrointestinal endoscopies for GERD.2 Chronic GERD and Barrett' s esophagus are risk factors for esophageal adenocarcinoma, which has one of the lowest cancer cure rates (10%).3 Screening strategies for esophageal cancer have therefore focused on identifying Barrett' s esophagus through upper gastrointestinal endoscopies in patients with chronic GERD symptoms. Surveillance endoscopy in patients with Barrett' s esophagus has been associated with earlier detection of esophageal cancer and improved survival. 4 Recent advances in technology have led to the development of an ultrathin video esophagoscope that can be introduced either orally or nasally in an unsedated patient to visualize the esophagus and gastroesophageal junction. A thinner and more fl exible scope may decrease patient discomfort and enhance overall tolerability of an unsedated examination. Unsedated ultrathin esophagoscopy (UUE) has been used to defi ne patho- [8][9][10][11][12] UUE has a sensitivity of 75% to 91% and a specifi city 98% to 99% for esophageal lesions, eg, hiatal hernia and esophagitis. 9,12 For diagnosis of Barret...

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

“…Thus, several endoscopy techniques have recently been developed as alternatives and less invasive diagnostic tools for evaluating GERD and esophageal varices [12][13][14][15][16]20] . Here, in this study we have shown that unsedated esophagoscopy using a novel disposable transnasal esophagoscope (E.G.…”

“…Several studies have shown that ECE is safe and has an acceptable accuracy for the evaluation of esophageal varices and can be used as an alternative to EGD for the screening of portal hypertension, especially in patients unable or unwilling to undergo EGD [7,9] . Unsedated small-caliber transnasal esophagoscopy offers the possibility of efficient and accurate endoscopic assessment of the esophagus, with less cost and fewer risks compared with sedated upper endoscopy, and can be used as a method to screen for esophageal disease in a primary care population [11][12][13][14][15] . Recently, Chung et al [16] , in a case series study, reported the use of a novel disposable transnasal esophagoscope, the E.G.…”

Nasolaryngoscopy in a Family Medicine Clinic: Indications, Findings, and Economics

“…After they provided informed consent, patients were anesthetized using a method we have described previously. 9 The procedures in this study were performed by or supervised by the lead author (TW) between February 2002 and April 2008 using either XEF-140Y1 gastrointestinal videoscope or ENF-P3 laryngoscope (Olympus America, Inc., Melville, NY). The XEF-140Y1 has an outer diameter of 4.0 mm at the insertion tube, a working length of 600 mm, a bending section that can be maneuvered upward 180 degrees and downward 90 degrees (with no right or left deflection), and a field of view of 120 degrees.…”

Randomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barrett's esophagus

“…18,19 Unsedated ultrathin transnasal endoscopy (TNE) can be feasible, well-tolerated, safe, and accurate in evaluating the esophagus. [20][21][22][23][24][25][26][27] A recent study suggested that it could be used accurately for BE screening and surveillance. 26 However, the applicability of this study may be limited because the level of agreement between the SE and TNE was only moderate ( ϭ 0.591) for diagnosing BE.…”