Standard esophagogastroduodenoscopy (EGD) is expensive. It also requires conscious sedation which may be poorly tolerated by cirrhotic patients.
In this study, researchers from the United States assessed unsedated esophagoscopy, using an ultrathin battery-powered endoscope (BPE), for diagnosing esophageal varices (EV).
Initially, the team retrospectively evaluated 199 cirrhotic patients undergoing liver transplant evaluation.
|Both procedures were well tolerated by all patients.|
|American Journal of Gastroenterology|
They determined the prevalence of significant gastroduodenal pathology, which could be missed if patients only underwent esophagoscopy. Of these patients, 3 had gastric ulcers, and 2 had duodenal ulcers.
The team then performed a prospective study to evaluate a BPE in EV screening. They evaluated 28 cirrhotic patients.
An unsedated per-oral endoscopy was performed by a single endoscopist using a BPE. This was followed by an EGD, performed by a second endoscopist who was blinded to the results of the BPE.
The research team used a visual analog score was used to determine patient tolerance to the procedure.
In addition, patients were questioned about their preferred method for endoscopy in the future.
The researchers diagnosed EV in 14 patients using a BPE, and 13 of these were confirmed by standard EGD.
EV were graded as large in 1 patient and small in 13 with a BPE, however small varices diagnosed in 1 patient were not confirmed on EGD.
Both procedures were well tolerated by all patients.
Overall, 27 of 28 patients preferred unsedated endoscopy with a BPE over EGD.
Dr Ravi Madhotra's team concluded, "Unsedated endoscopy with a BPE is safe and well tolerated".
"The diagnostic accuracy of a BPE for diagnosing EV is the same as by EGD".
"Esophagoscopy with a BPE is a potential alternative to EGD for EV screening".