A major limitation to screening and surveillance of Barrett's esophagus is the complexity, expense, and risk associated with sedation for upper endoscopy.
Dr Blair Jobe and colleagues from Oregon examined the feasibility, accuracy, and patient acceptability of office-based unsedated endoscopy as an alternative.
The team identified 274 eligible adults scheduled for endoscopic screening for gastroesophageal reflux symptoms or surveillance of Barrett's esophagus.
Of these, 121 underwent unsedated small-caliber endoscopy and conventional endoscopy in a randomized crossover study.
|Barrett's prevalence was 30% with unsedated endoscopy|
|American Journal of Gastroenterology|
The research team compared the 2 procedures with regard to histological detection of Barrett's esophagus and dysplasia, and biopsy size.
Patients answered questionnaires assessing the tolerability of the procedures.
The team found that the prevalence of Barrett's esophagus was 26% using conventional endoscopy, and 30% using unsedated endoscopy.
The level of agreement between the 2 approaches was moderate.
The researchers noted that each modality detected 4 cases of low-grade dysplasia with concordance on 1 case.
The tissue samples collected with unsedated endoscopy were smaller than with conventional endoscopy.
The team observed that 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% chose unsedated small-caliber endoscopy.
Dr Jobe's team concludes, “Office-based unsedated small-caliber endoscopy is technically feasible, well tolerated.”
“It is 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.”