Office-Based Unsedated Small-Caliber Endoscopy Is... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

ORIGINAL CONTRIBUTIONS: ESOPHAGUS

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

Jobe, Blair A. M.D.1,2; Hunter, John G. M.D.1; Chang, Eugene Y. M.D.1,2; Kim, Charles Y. M.D.1,2; Eisen, Glenn M. M.D., M.P.H.3; Robinson, Jedediah D. M.S.1; Diggs, Brian S. Ph.D.1; O'Rourke, Robert W. M.D.1; Rader, Anne E. M.D.4; Schipper, Paul M.D.1; Sauer, David A. M.D.4,5; Peters, Jeffrey H. M.D.6; Lieberman, David A. M.D.3; Morris, Cynthia D. Ph.D., M.P.H.7

1Department of Surgery, Oregon Health and Science University, Portland, Oregon

2Surgical Services, Portland VA Medical Center, Portland, Oregon

3Division of Gastroenterology, Oregon Health and Science University, Portland, Oregon

4Department of Pathology, Oregon Health and Science University, Portland, Oregon

5Pathology Services, Portland VA Medical Center, Portland, Oregon

6Department of Surgery, University of Rochester, Rochester, New York

7Department of Epidemiology and Outcomes Research, Oregon Health and Science University, Portland, Oregon

Reprint requests and correspondence: Blair A. Jobe, M.D., Portland VA Medical Center, Surgical Service – P3GS, PO Box 1034, Portland, Oregon 97207.

CONFLICT OF INTEREST

Guarantor of the article: Dr. Blair Jobe is identified as the guarantor of this submission.

Specific author contributions: Blair A. Jobe, M.D.—study planning, study conducting drafting manuscript. John G. Hunter, M.D.—study planning, drafting manuscript. Charles Y. Kim, M.D.—study conducting. Glenn M. Eisen, M.D. M.Ph.—study conducting. Eugene Y. Chang, M.D.—study conducting, drafting manuscript. Jedediah D. Robinson, M.S.—study conducting. Brian S. Diggs, Ph.D.—study planning. Robert W. O.'Rourke, M.D.—drafting manuscript. Anne E. Rader, M.D.—study conducting. Paul Schipper, M.D.—drafting manuscript. David A. Sauer, M.D.—study conducting. Jeffrey H. Peters, M.D.—study planning. David A. Lieberman, M.D.—study planning, drafting manuscript. Cynthia D. Morris, Ph.D., M.Ph.—study planning, drafting manuscript. The authors have approved the final draft submitted.

Financial support: This work was supported by National Institutes of Health grants K23 DK066165-01 (BAJ), RO3 CA105959-01 (BAJ), PHS Grant 5 M01 RR000334, and 2U01DK057132-06A1 (DAL). Equipment for this investigation was supplied by Olympus America, Inc.

Potential competing interests: The authors have no additional conflicts of interests to disclose.

Received April 6, 2006; accepted August 1, 2006.

Abstract

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” (κ = 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.