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DOI: 10.1055/s-0043-102937
Endoscopic screening for Barrett’s esophagus: while we’re in, do we also need to see the stomach and the duodenum?
Publication History
submitted 25 January 2017
accepted after revision 01 February 2017
Publication Date:
05 May 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00025476/201705/lookinside/thumbnails/821_10-1055-s-0043-102937-1.jpg)
In this issue of Endoscopy International Open, the Mayo Clinic team of Dr. Iyer Prasad published a comparative quality assessment of the endoscopy videos recorded in their previous published work on Barrett esophagus screening [1] [2]. Their initial work compared the yield of 2 different endoscopic examinations: unsedated transnasal esophagoscopy (uTNE) and sedated esophago-gastro-duodenoscopy (sEGD).
In uTNE, the tube is covered with a single-use plastic sheath that makes sterilization between procedures unnecessary (Endosheath, TNE-5000, Vision Sciences, Orangeburg, NY, USA). The endoscope’s sheath has an outer parallel biopsy channel made from the same material. Due to its short length, it can only examine the esophagus. In sEGD, a standard high-definition 9.8-m endoscope (GIF-180, Olympus America, Center Valley, PA, USA) is used.
Transnasal esophagoscopy (TNE) was used both in hospital (huTNE) and in a community setting through a specially designed mobile research vehicle (muTNE). Esophago-gastro-duodenoscopy (EGD) was used in hospital. The screening population consisted of individuals aged older than 50, with or without gastroesophageal reflux disease (GERD) symptoms.
The conclusion of the first study [1] was that both hospital and mobile van uTNE screening had comparable clinical effectiveness to sEGD (complete examination of the esophagus in 96 % to 100 % of cases, and similar participation rates [40 % to 45 %] and safety profile). Mean recovery time with uTNE was significantly shorter compared to sEGD (15 minutes versus 1 hour). Rates of successful biopsy acquisition were significantly lower in the uTNE groups compared to sEGD due to inability to advance the TNE scope with the biopsy sheath through narrow nasal passages and patient intolerance (80 % versus 100 %), but switching to a smaller sheath allowed subsequent esophageal examination [1] [3]. Esophagitis was diagnosed in 32 % and Barrett esophagus in 8 % of screened individuals [1].
The current study [2] published in Endoscopy International Open expands upon the previous findings and concludes that the overall quality and gastroesophageal junction visualization of uTNE and sEGD are comparable.
To better understand the big picture in which this paper appears, we need to ask ourselves a few questions.
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References
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