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Sijben J, Peters Y, van der Velden K, Rainey L, Siersema PD, Broeders MJ. Public acceptance and uptake of oesophageal adenocarcinoma screening strategies: A mixed-methods systematic review. EClinicalMedicine 2022; 46:101367. [PMID: 35399814 PMCID: PMC8987366 DOI: 10.1016/j.eclinm.2022.101367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED Oesophageal adenocarcinoma (OAC) is increasingly diagnosed and often fatal, thus representing a growing global health concern. Screening for its precursor, Barrett's oesophagus (BO), combined with endoscopic surveillance and treatment of dysplasia might prevent OAC. This review aimed to systematically explore the public's acceptance and uptake of novel screening strategies for OAC. We systematically searched three electronic databases (Ovid Medline/PubMed, Ovid EMBASE and PsycINFO) from date of inception to July 2, 2021 and hand-searched references to identify original studies published in English on acceptability and uptake of OAC screening. Two reviewers independently reviewed and appraised retrieved records and two reviewers extracted data (verified by one other reviewer). Of the 3674 unique records, 19 studies with 15 249 participants were included in the review. Thematic analysis of findings showed that acceptability of OAC screening is related to disease awareness, fear, belief in benefit, practicalities and physical discomfort. The findings were mapped on the Integrated Screening Action Model. Minimally invasive screening tests are generally well-tolerated: patient-reported outcomes were reported for sedated upper endoscopy (tolerability ++), transnasal endoscopy (tolerability +), tethered capsule endomicroscopy (tolerability +/-), and the Cytosponge-TFF3 test (acceptability ++). In discrete choice experiments, individuals mainly valued screening test accuracy. OAC screening has been performed in trials using conventional upper endoscopy (n = 231 individuals), transnasal endoscopy (n = 966), capsule endoscopy (n = 657) and the Cytosponge-TFF3 test (n = 9679), with uptake ranging from 14·5% to 48·1%. Intended participation in OAC screening in questionnaire-based studies ranged from 62·8% to 71·4%. We conclude that the general public seems to have interest in OAC screening. The findings will provide input for the design of a screening strategy that incorporates the public's values and preferences to improve informed participation. Identification of a screening strategy effective in reducing OAC mortality and morbidity remains a crucial prerequisite. FUNDING This study was funded by the Netherlands Organization for Health Research and Development (ZonMw) under grant 555,004,206.
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Affiliation(s)
- Jasmijn Sijben
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud university medical center, Geert Grooteplein-Zuid 8, Nijmegen 6500 HB, the Netherland
- Corresponding author.
| | - Yonne Peters
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud university medical center, Geert Grooteplein-Zuid 8, Nijmegen 6500 HB, the Netherland
| | - Kim van der Velden
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud university medical center, Geert Grooteplein-Zuid 8, Nijmegen 6500 HB, the Netherland
| | - Linda Rainey
- Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein-Zuid 8, Nijmegen 6500 HB, the Netherland
| | - Peter D. Siersema
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud university medical center, Geert Grooteplein-Zuid 8, Nijmegen 6500 HB, the Netherland
| | - Mireille J.M. Broeders
- Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein-Zuid 8, Nijmegen 6500 HB, the Netherland
- Dutch Expert Centre for Screening, Wijchenseweg 101, Nijmegen 6538 SW, the Netherland
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Groulx S, Limburg H, Doull M, Klarenbach S, Singh H, Wilson BJ, Thombs B. Guideline on screening for esophageal adenocarcinoma in patients with chronic gastroesophageal reflux disease. CMAJ 2021; 192:E768-E777. [PMID: 32631908 DOI: 10.1503/cmaj.190814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Stéphane Groulx
- Department of Community Health Sciences (Groulx), University of Sherbrooke, Sherbrooke, Que.; Public Health Agency of Canada (Limburg, Doull), Ottawa, Ont.; Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Community Health and Humanities (Wilson), Memorial University, St. John's, Nfld.; Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - Heather Limburg
- Department of Community Health Sciences (Groulx), University of Sherbrooke, Sherbrooke, Que.; Public Health Agency of Canada (Limburg, Doull), Ottawa, Ont.; Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Community Health and Humanities (Wilson), Memorial University, St. John's, Nfld.; Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - Marion Doull
- Department of Community Health Sciences (Groulx), University of Sherbrooke, Sherbrooke, Que.; Public Health Agency of Canada (Limburg, Doull), Ottawa, Ont.; Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Community Health and Humanities (Wilson), Memorial University, St. John's, Nfld.; Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - Scott Klarenbach
- Department of Community Health Sciences (Groulx), University of Sherbrooke, Sherbrooke, Que.; Public Health Agency of Canada (Limburg, Doull), Ottawa, Ont.; Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Community Health and Humanities (Wilson), Memorial University, St. John's, Nfld.; Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - Harminder Singh
- Department of Community Health Sciences (Groulx), University of Sherbrooke, Sherbrooke, Que.; Public Health Agency of Canada (Limburg, Doull), Ottawa, Ont.; Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Community Health and Humanities (Wilson), Memorial University, St. John's, Nfld.; Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - Brenda J Wilson
- Department of Community Health Sciences (Groulx), University of Sherbrooke, Sherbrooke, Que.; Public Health Agency of Canada (Limburg, Doull), Ottawa, Ont.; Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Community Health and Humanities (Wilson), Memorial University, St. John's, Nfld.; Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
| | - Brett Thombs
- Department of Community Health Sciences (Groulx), University of Sherbrooke, Sherbrooke, Que.; Public Health Agency of Canada (Limburg, Doull), Ottawa, Ont.; Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Community Health and Humanities (Wilson), Memorial University, St. John's, Nfld.; Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que
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Hamel C, Ahmadzai N, Beck A, Thuku M, Skidmore B, Pussegoda K, Bjerre L, Chatterjee A, Dennis K, Ferri L, Maziak DE, Shea BJ, Hutton B, Little J, Moher D, Stevens A. Screening for esophageal adenocarcinoma and precancerous conditions (dysplasia and Barrett's esophagus) in patients with chronic gastroesophageal reflux disease with or without other risk factors: two systematic reviews and one overview of reviews to inform a guideline of the Canadian Task Force on Preventive Health Care (CTFPHC). Syst Rev 2020; 9:20. [PMID: 31996261 PMCID: PMC6990541 DOI: 10.1186/s13643-020-1275-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Two reviews and an overview were produced for the Canadian Task Force on Preventive Health Care guideline on screening for esophageal adenocarcinoma in patients with chronic gastroesophageal reflux disease (GERD) without alarm symptoms. The goal was to systematically review three key questions (KQs): (1) The effectiveness of screening for these conditions; (2) How adults with chronic GERD weigh the benefits and harms of screening, and what factors contribute to their preferences and decision to undergo screening; and (3) Treatment options for Barrett's esophagus (BE), dysplasia or stage 1 EAC (overview of reviews). METHODS Bibliographic databases (e.g. Ovid MEDLINE®) were searched for each review in October 2018. We also searched for unpublished literature (e.g. relevant websites). The liberal accelerated approach was used for title and abstract screening. Two reviewers independently screened full-text articles. Data extraction and risk of bias assessments were completed by one reviewer and verified by another reviewer (KQ1 and 2). Quality assessments were completed by two reviewers independently in duplicate (KQ3). Disagreements were resolved through discussion. We used various risk of bias tools suitable for study design. The GRADE framework was used for rating the certainty of the evidence. RESULTS Ten studies evaluated the effectiveness of screening. One retrospective study reported no difference in long-term survival (approximately 6 to 12 years) between those who had a prior esophagogastroduodenoscopy and those who had not (adjusted HR 0.93, 95% confidence interval (CI) 0.58-1.50). Though there may be higher odds of a stage 1 diagnosis than a more advanced diagnosis (stage 2-4) if an EGD had been performed in the previous 5 years (OR 2.27, 95% CI 1.00-7.67). Seven studies compared different screening modalities, and showed little difference between modalities. Three studies reported on patients' unwillingness to be screened (e.g. due to anxiety, fear of gagging). Eleven systematic reviews evaluated treatment modalities, providing some evidence of early treatment effect for some outcomes. CONCLUSIONS Little evidence exists on the effectiveness of screening and values and preferences to screening. Many treatment modalities have been evaluated, but studies are small. Overall, there is uncertainty in understanding the effectiveness of screening and early treatments. SYSTEMATIC REVIEW REGISTRATIONS PROSPERO (CRD42017049993 [KQ1], CRD42017050014 [KQ2], CRD42018084825 [KQ3]).
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Affiliation(s)
- Candyce Hamel
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada.
| | - Nadera Ahmadzai
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada
| | - Andrew Beck
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada
| | - Micere Thuku
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada
| | - Becky Skidmore
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada
| | - Kusala Pussegoda
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada
| | - Lise Bjerre
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Avijit Chatterjee
- Gastroenterology Department, Faculty of Medicine, Unveristy of Ottawa, Ottawa, ON, Canada
| | - Kristopher Dennis
- Ottawa Hospital Research Institute, Cancer Therapeutics Program, Ottawa, ON, Canada
| | - Lorenzo Ferri
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University, Montreal, QC, Canada
| | - Donna E Maziak
- Department of Surgery and The Ottawa Hospital, Department of Thoracic Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Beverley J Shea
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - David Moher
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Adrienne Stevens
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada
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Schuldt AL, Kirsten H, Tuennemann J, Heindl M, van Bommel F, Feisthammel J, Hollenbach M, Hoffmeister A. Necessity of transnasal gastroscopy in routine diagnostics: a patient-centred requirement analysis. BMJ Open Gastroenterol 2019; 6:e000264. [PMID: 31139423 PMCID: PMC6506089 DOI: 10.1136/bmjgast-2018-000264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/10/2019] [Accepted: 02/22/2019] [Indexed: 12/14/2022] Open
Abstract
Introduction Numerous indications require regular upper gastrointestinal endoscopy (oesophagogastroduodenoscopy; EGD) in outpatients. In most cases, peroral gastroscopy is performed. The aim of this study was to evaluate the need of transnasal gastroscopy (nEGD) in outpatients. Methods A questionnaire was used to assess patients’ preferred choice of method, previous experience with EGD, psychological aspects and sociodemographic data. Furthermore, patient satisfaction with and potentially perceived discomfort during the examination as well as preference for a method in regard to future examinations was evaluated. Results From September 2016 to March 2017, a total of 283 outpatients at endoscopy of the University Hospital of Leipzig were approached to participate in the study. 196 patients were eligible, of whom 116 (60%) chose nEGD. For 87 patients (87/283, 31%) nEGD had to be excluded for medical reasons. The average age in the total sample was 53 (±17) years. 147 (77%) have had previous experience with peroral EGD (oEGD). Of the nEGD examined patients 83% were fairly up to extremely satisfied with the procedure. Satisfaction significantly predicted the choice of future EGD examinations. Nasal pain experienced during nEGDs was associated with rejection of nEGD in further EGD examinations (p<0.01). Patients who did choose a specific procedure were more likely to select the same procedure as their future preference (χ²= 73.6, df=1, p<0.001); this preference was unaffected by the procedure that had been chosen previously (reselecting nEGD: 84%, oEGD: 89%, p=0.874). Conclusion nEGD without sedation is a viable alternative. Patient satisfaction with nEGD is high, and reselection rate for nEGD is similar to that for oEGD. As a result of this study nEGD is now offered as a routine procedure at the University of Leipzig. Trial registration number NCT03663491.
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Affiliation(s)
- Anna-Livia Schuldt
- Division of Gastroenterology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig, Leipzig, Germany
| | - Holger Kirsten
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Leipzig, Germany
| | - Jan Tuennemann
- Division of Gastroenterology, University Hospital Leipzig, Leipzig, Germany
| | - Mario Heindl
- Division of Gastroenterology, University Hospital Leipzig, Leipzig, Germany
| | - Florian van Bommel
- Klinik für Gastroenterologie und Rheumatologie, University Hospital Leipzig, Leipzig, Germany
| | - Juergen Feisthammel
- Division of Gastroenterology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig, Leipzig, Germany
| | - Marcus Hollenbach
- Division of Gastroenterology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig, Leipzig, Germany
| | - Albrecht Hoffmeister
- Division of Gastroenterology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig, Leipzig, Germany
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Wellenstein DJ, Schutte HW, Marres HAM, Honings J, Belafsky PC, Postma GN, Takes RP, van den Broek GB. Office-based procedures for diagnosis and treatment of esophageal pathology. Head Neck 2017; 39:1910-1919. [DOI: 10.1002/hed.24819] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- David J. Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Henrieke W. Schutte
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Henri A. M. Marres
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Peter C. Belafsky
- Center for Voice and Swallowing; Department of Otolaryngology and Head and Neck Surgery, University of California, Davis School of Medicine; Sacramento California
| | - Gregory N. Postma
- Department of Otolaryngology; Medical College of Georgia at Augusta University; Augusta Georgia
| | - Robert P. Takes
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Guido B. van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
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Parker C, Alexandridis E, Plevris J, O'Hara J, Panter S. Transnasal endoscopy: no gagging no panic! Frontline Gastroenterol 2016; 7:246-256. [PMID: 28839865 PMCID: PMC5369487 DOI: 10.1136/flgastro-2015-100589] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/01/2015] [Accepted: 06/10/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Transnasal endoscopy (TNE) is performed with an ultrathin scope via the nasal passages and is increasingly used. This review covers the technical characteristics, tolerability, safety and acceptability of TNE and also diagnostic accuracy, use as a screening tool and therapeutic applications. It includes practical advice from an ear, nose, throat (ENT) specialist to optimise TNE practice, identify ENT pathology and manage complications. METHODS A Medline search was performed using the terms "transnasal", "ultrathin", "small calibre", "endoscopy", "EGD" to identify relevant literature. RESULTS There is increasing evidence that TNE is better tolerated than standard endoscopy as measured using visual analogue scales, and the main area of discomfort is nasal during insertion of the TN endoscope, which seems remediable with adequate topical anaesthesia. The diagnostic yield has been found to be similar for detection of Barrett's oesophagus, gastric cancer and GORD-associated diseases. There are some potential issues regarding the accuracy of TNE in detecting small early gastric malignant lesions, especially those in the proximal stomach. TNE is feasible and safe in a primary care population and is ideal for screening for upper gastrointestinal pathology. It has an advantage as a diagnostic tool in the elderly and those with multiple comorbidities due to fewer adverse effects on the cardiovascular system. It has significant advantages for therapeutic procedures, especially negotiating upper oesophageal strictures and insertion of nasoenteric feeding tubes. CONCLUSIONS TNE is well tolerated and a valuable diagnostic tool. Further evidence is required to establish its accuracy for the diagnosis of early and small gastric malignancies. There is an emerging role for TNE in therapeutic endoscopy, which needs further study.
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Affiliation(s)
- Clare Parker
- South Tyneside NHS Foundation Trust, South Tyneside District Hospital, South Shields, UK
| | | | - John Plevris
- Centre for Liver and Digestive Disorders, The Royal Infirmary, University of Edinburgh, Edinburgh, UK
| | - James O'Hara
- Department of Otolaryngology, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Simon Panter
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, Newcastle upon Tyne, UK
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Sami SS, Subramanian V, Ortiz-Fernández-Sordo J, Saeed A, Singh S, Guha IN, Iyer PG, Ragunath K. Performance characteristics of unsedated ultrathin video endoscopy in the assessment of the upper GI tract: systematic review and meta-analysis. Gastrointest Endosc 2015; 82:782-92. [PMID: 26371850 DOI: 10.1016/j.gie.2015.07.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 07/07/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS Reports on the performance of unsedated ultrathin endoscopy via the transnasal (uTNE) and transoral (uTOE) routes are conflicting. We aimed to estimate the technical success rate, patient preference, and acceptability of uTNE and uTOE alone and in comparison with conventional EGD (cEGD; with or without sedation). METHODS A systematic review and meta-analysis was performed on all primary studies reporting the outcomes of interest. Electronic databases (Cochrane library, MEDLINE, EMBASE) were searched on February 1, 2014. RESULTS Thirty-four studies met the inclusion criteria with 6659 patients in total. The pooled technical success rate was 94.0% for uTNE (95% confidence interval [CI], 91.6-95.8; 30 studies) and 97.8% for uTOE (95% CI, 95.6-98.9; 16 studies). The difference in proportion of success for uTNE compared with cEGD was -2.0% (95% CI, -4.0 to -1.0; 18 studies), but that difference was not significant when uTNE < 5.9 mm in diameter was used (-1.0%; 95% CI, -3.0 to .0; 9 studies). There was no significant difference in success rate between uTOE and cEGD (.0%; 95% CI, -1.0 to 2.0; 10 studies). The pooled difference in proportion of patients who preferred uTNE over cEGD was 63.0% (95% CI, 49.0-76.0; 10 studies), whereas preference for uTOE versus cEGD was not significantly different (38.0%; 95% CI, -4.0 to 80.0; 2 studies). Acceptability was high for both uTNE (85.2%; 95% CI, 79.1-89.9; 16 studies) and uTOE (88.7%; 95% CI, 82.4-92.9; 10 studies). CONCLUSIONS Technical success rate for uTNE < 5.9 mm is equivalent to cEGD. uTNE has high patient acceptability, with better patient preference, and therefore could be a useful alternative to cEGD for screening purposes. uTOE had a similar technical success rate but an equivocal preference to cEGD.
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Affiliation(s)
- Sarmed S Sami
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Venkataraman Subramanian
- Molecular Gastroenterology, Institute of Biomedical and Clinical Sciences, University of Leeds, and Center for Digestive Diseases, St James University Hospital, Leeds, UK
| | - Jacobo Ortiz-Fernández-Sordo
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Alhussain Saeed
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Siddharth Singh
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Indra N Guha
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Prasad G Iyer
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Krish Ragunath
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
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Kiriyama S, Naitoh H, Kuwano H. Propofol sedation during endoscopic treatment for early gastric cancer compared to midazolam. World J Gastroenterol 2014; 20:11985-11990. [PMID: 25232235 PMCID: PMC4161786 DOI: 10.3748/wjg.v20.i34.11985] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/26/2013] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) has been proposed as the gold standard in the treatment of early gastric cancer because it facilitates a more accurate histological assessment and reduces the risk of tumor recurrence. However, the time course of ESD for large gastric tumors is frequently prolonged because of the tumor size and technical difficulties and typically requires higher doses of sedative and pain-controlling drugs. Sedative or anesthetic drugs such as midazolam or propofol are used during the procedure. Therapeutic endoscopy of early gastric cancers can often be performed with only moderate sedation. Compared with midazolam, propofol has a very fast onset of action, short plasma half-life and time to achieve sedation, faster time to recovery and discharge, and results in higher patient satisfaction. For overall success, maintaining safety and stability not only during the procedure but also subsequently in the recovery room and ward is necessary. In obese patients, it is recommended that the injected dose be based on a calculated standard weight. Cooperation between gastroenterologists, surgeons, and anesthesiologists is imperative for a successful ESD procedure.
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Alexandridis E, Inglis S, McAvoy NC, Falconer E, Graham C, Hayes PC, Plevris JN. Randomised clinical study: comparison of acceptability, patient tolerance, cardiac stress and endoscopic views in transnasal and transoral endoscopy under local anaesthetic. Aliment Pharmacol Ther 2014; 40:467-76. [PMID: 25039412 DOI: 10.1111/apt.12866] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 06/10/2014] [Accepted: 06/19/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Transnasal endoscopy (TNE) with ultrathin endoscopes has been advocated as an attractive alternative, for diagnostic upper endoscopy. AIM To assess tolerability, acceptability and quality of TNE, in comparison with standard upper endoscopy (SOGD, standard oesophago-gastro-duodenoscopy) under local anaesthetic. METHODS We prospectively recruited 157 patients (83 females/74 males) mean age 57 years. The Fujinon EG530N (5.9 mm) and EG530WR (9.4 mm) endoscopes were used. The endoscopist and all patients completed detailed questionnaires regarding tolerability, acceptance and quality of endoscopy using standard visual analogue scales (VAS). Oxygen saturation (SaO2 ), heart rate (HR) and systolic blood pressure (SBP) were recorded. Quality of biopsies was evaluated. RESULTS Analysis included 161 procedures (TNE:79, SOGD:82) with duodenal intubation achieved in all patients. VAS scores for patient comfort were significantly better in the TNE group (7.3 vs. 5.3 respectively, P < 0.001). Twenty patients with previous experience of standard endoscopy were randomised to TNE and 19 of them (95.5%) preferred the TNE. Gagging was significantly less in the TNE group (0.12 vs. 3.41 respectively, P < 0.001). Cardiovascular stress was significantly less in the TNE group irrespective of the degree of gagging or comfort. TNE biopsies were smaller, but adequate for definitive diagnosis, similarly to standard endoscopy. CONCLUSIONS Transnasal endoscopy is superior to SOGD in terms of comfort and patient acceptance with significantly less cardiovascular stress. TNE can routinely be used as alternative to SOGD under local anaesthetic, for diagnosis and should be preferentially offered in cardiorespiratory compromised patients.
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Affiliation(s)
- E Alexandridis
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
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Peery AF, Hoppo T, Garman KS, Dellon ES, Daugherty N, Bream S, Sanz AF, Davison J, Spacek M, Connors D, Faulx AL, Chak A, Luketich JD, Shaheen NJ, Jobe BA. Feasibility, safety, acceptability, and yield of office-based, screening transnasal esophagoscopy (with video). Gastrointest Endosc 2012; 75:945-953.e2. [PMID: 22425272 PMCID: PMC4154478 DOI: 10.1016/j.gie.2012.01.021] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 01/12/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Endoscopic screening for esophageal neoplasia can identify patients eligible for early intervention for precancerous lesions. Unsedated transnasal esophagoscopy may provide an efficient and accurate endoscopic assessment with fewer risks and less cost, compared with conventional upper endoscopy. OBJECTIVE To assess the feasibility, safety, acceptability, and yield of unsedated transnasal esophagoscopy in a primary care population. DESIGN Multicenter, prospective, cross-sectional study. SETTING Two outpatient tertiary-care centers. PATIENTS This study involved a general medical clinic population aged between 40 and 85 years. INTERVENTION Unsedated, office-based transnasal esophagoscopy. MAIN OUTCOME MEASUREMENTS Procedure yield; completeness of examination; procedure length; adverse events and complications; choking, gagging, pain, or anxiety during the examination; and overall tolerability. RESULTS A total of 426 participants (mean [± standard deviation] age 55.8 ± 9.5 years; 43% male) enrolled in the study, and 422 (99%) completed the examination. Mean (± standard deviation) examination time was 3.7 ± 1.8 minutes. There were no serious adverse events, and 12 participants (2.8%) reported minor complications. Participants reported minimal choking, gagging, pain, or anxiety. The examination was well-tolerated by most participants. Overall, 38% of participants had an esophageal finding that changed management (34% erosive esophagitis, 4% Barrett's esophagus). LIMITATIONS Nonrandomized study, tertiary-care centers only, self-selected population with a large proportion reporting esophageal symptoms. CONCLUSION Unsedated transnasal esophagoscopy is a feasible, safe, and well-tolerated method to screen for esophageal disease in a primary care population. Endoscopic findings are common in this patient population.
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Affiliation(s)
- Anne F. Peery
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Evan S. Dellon
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Norma Daugherty
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Susan Bream
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Melissa Spacek
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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