Unsedated Transnasal Endoscopy for Detecting Barrett Esophagus

Barrett Esophagus
Barrett Esophagus
Researchers examined the safety, tolerability, diagnostic accuracy, and technical success rate of unsedated transnasal endoscopy vs conventional esophagogastroduodenoscopy for diagnosing Barrett esophagus.

Unsedated transnasal endoscopy (uTNE) is accurate, safe, and well-tolerated for detecting columnar epithelium and may be used as an endoscopic screening method for Barrett esophagus (BE), according to a study in Diseases of the Esophagus.

The systematic review and meta-analysis evaluated the diagnostic accuracy, patient tolerability, technical success rate, and safety of uTNE compared with conventional esophagogastroduodenoscopy (cEGD) for detecting BE and related neoplasia.

Researchers searched the PubMed, EMBASE, and Cochrane Library databases for articles published up to March 2022. Eligible studies compared uTNE with cEGD for detecting BE and related neoplasia for at least 1 of the following: sensitivity, specificity, positive predictive value, and negative predictive value.

The primary outcome was the diagnostic accuracy of uTNE vs cEGD for detecting columnar epithelium, intestinal metaplasia, and related neoplasia.

After removing duplicates, researchers identified 7711 studies. A total of 8 articles with 683 patients were included, of whom 623 participants successfully completed uTNE and cEGD. The pooled sensitivity of uTNE for detecting columnar epithelium was 98% (95% CI, 83%-100%), and the pooled specificity was 99% (95% CI, 82%-100%). The I2 statistic was 40.3%, representing moderate heterogeneity.

The pooled sensitivity of uTNE for detecting intestinal metaplasia in biopsies was 89% (95% CI, 78%-95%), and the pooled specificity was 93% (95% CI, 71%-98%). The I2 statistic was 0.0%, indicating low heterogeneity.

Among the included studies, 3 reported increased patient tolerability of uTNE compared with cEGD. No difference in patient tolerability was observed in the other 3 studies.

In 7 studies, the technical success rate of uTNE ranged from 89% to 100%, and it was unknown in 1 study. The overall log-odds-ratio was 1.09 (95% CI, 0.29-2.47), suggesting similar technical success rates for uTNE and cEGD.

No serious adverse events were reported in 6 studies, and 2 studies did not report adverse events.

Study limitations include the inability to perform a bivariate regression model of covariates (country, model of ultrathin endoscope, and population) due to the small number of studies per subgroup; only classifying certain studies as low risk for bias; and including only 3 studies on dysplasia detection.

Researchers concluded, “uTNE is an accurate, safe, and well tolerated endoscopic procedure for the detection of columnar epithelium and has the potential to be used as an endoscopic screening method for BE. Therefore, it seems logical to implement the use of uTNE in current guidelines on BE screening.”

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.

Reference

Huibertse LJ, Peters Y, Westendorp D, Siersema PD. Unsedated transnasal endoscopy for the detection of Barrett’s esophagus: systematic review and meta-analysis. Dis Esophagus. Published online July 14, 2022. doi:10.1093/dote/doac045