Screening for Barrett's esophagus, and esophageal adenocarcinoma is not recommended because it was not found to be cost effective.
However, physician extenders are able to perform unsedated procedures.
Their involvement might reduce the costs of Barrett's esophagus screening.
Dr Amitabh Chak and colleagues from Ohio, USA examined the feasibility of training physician extenders to independently perform transnasal esophagoscopy (TNE) and screen patients for Barrett's esophagus, and measured their learning curve.
The team reported that 2 PEs at a Veterans Affairs (VA) medical center underwent a structured didactic training program, and observed nasopharyngoscopies before performing TNE under the supervision of attending endoscopists.
Individual technical and cognitive components of transnasal esophagoscopy were rated on a 9-point structured scale.
|They acquired overall competence after supervised training on 43 and 47 procedures, respectively|
|Clinical Gastroenterology & Hepatology|
Learning curves were constructed using cumulative summation.
Once the physician extenders were judged to be technically competent, each physician extender performed 10 independent videotaped transnasal esophagoscopy, which were graded.
The researchers observed that both physician extenders identified anatomic landmarks after 18 consecutive procedures.
Physician extenders 1 and 2 performed satisfactory nasal intubations after 20 and 25 procedures, and esophageal intubations after 29 and 35 procedures, respectively.
They acquired overall competence after supervised training on 43 and 47 procedures, respectively.
Dr Chak and team conclude, "We developed a program at a VA medical center to train physician extenders to perform transnasal esophagoscopy to screen for Barrett's esophagus."
"The physician extenders were able to perform transnasal esophagoscopy, and recognize esophageal landmarks independently after a modest number of supervised procedures."