Office-based unsedated small-caliber endoscopy is equivalent to conventional sedated endoscopy in screening and surveillance for Barrett's esophagus: A randomized and blinded comparison
Office-based unsedated small-caliber endoscopy is equivalent to conventional sedated endoscopy in screening and surveillance for Barrett's esophagus: A randomized and blinded comparison
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DOI：
10.1111/j.1572-0241.2006.00890.x
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发表时间：
2006-12-01
影响因子：
9.8
通讯作者：
Morris, Cynthia D.
中科院分区：
文献类型：
--
作者：
Jobe, Blair A.;Hunter, John G.;Morris, Cynthia D.
目的：Barrett食管筛查和监测的一个主要限制是复杂性、费用和与上消化道内窥镜检查镇静相关的风险。本研究探讨的可行性，准确性和患者的可接受性办公室为基础的unsedated内镜作为alternatives.METHODS：274符合条件的成年人安排内镜筛查胃食管反流症状或监测巴雷特食管在三级保健中心，121进行了unsedated小口径内镜和传统的内镜检查在一项随机交叉研究。比较两种方法在Barrett食管和异型增生的组织学检测和活检大小方面的差异。患者回答问卷评估的耐受性的proceedings.Results：巴雷特食管的患病率为26%，使用传统的内窥镜检查和30%，使用unsedated内窥镜检查（P= 0.503）。两种方法之间的一致性水平为“中等”（kappa= 0.591）。每种方法检测到4例低度异型增生，其中1例一致。非镇静剂内镜下采集的组织样本量小于常规内镜下采集的组织样本量（P < 0.001）。大多数受试者将其两种手术的经验评定为耐受良好，困难极小或无困难。当被问及他们更喜欢在未来的程序，71%（81/114）选择unseeded小口径endoscopy.CONCLUSIONS：ESTA为基础的unseeded小口径内镜技术上是可行的，耐受性良好，准确筛选巴雷特食管，尽管产生一个较小的活检标本。这种方法有可能消除这种应用中静脉镇静所需的基础设施和成本。
OBJECTIVES: A major limitation to screening and surveillance of Barrett's esophagus is the complexity, expense, and risk associated with sedation for upper endoscopy. This study examines the feasibility, accuracy, and patient acceptability of office-based unsedated endoscopy as an alternative.METHODS: Of 274 eligible adults scheduled for endoscopic screening for gastroesophageal reflux symptoms or surveillance of Barrett's esophagus at a tertiary care center, 121 underwent unsedated small-caliber endoscopy and conventional endoscopy in a randomized crossover study. The two procedures were compared with regard to histological detection of Barrett's esophagus and dysplasia and biopsy size. Patients answered questionnaires assessing the tolerability of the procedures.RESULTS: The prevalence of Barrett's esophagus was 26% using conventional endoscopy and 30% using unsedated endoscopy (P= 0.503). The level of agreement between the two approaches was "moderate" (kappa= 0.591). Each modality detected four cases of low-grade dysplasia with concordance on one case. The tissue samples collected with unsedated endoscopy were smaller than with conventional endoscopy (P < 0.001). The majority of subjects rated their experience with both procedures as being well tolerated with minimal or no difficulty. When asked which procedure they would prefer in the future, 71% (81/114) chose unsedated small-caliber endoscopy.CONCLUSIONS: Office-based unsedated small-caliber endoscopy is technically feasible, well tolerated, and accurate in screening for Barrett's esophagus, despite yielding a smaller biopsy specimen. This approach bears the potential to eliminate the infrastructure and cost required for intravenous sedation in this application.