Unsedated transnasal endoscopy: a new technique for accurately detecting and grading esophageal varices in cirrhotic patients. Am J Gastroenterol 2002 Sep;97(9):2246-9
Date
10/03/2002Pubmed ID
12358240DOI
10.1111/j.1572-0241.2002.05906.xScopus ID
2-s2.0-0036732698 (requires institutional sign-in at Scopus site) 57 CitationsAbstract
OBJECTIVES: Endoscopic screening of cirrhotics for large esophageal varices (EV) is advocated before initiation of prophylactic therapy for variceal bleeding. Conscious sedation for conventional endoscopy is problematic in cirrhotic patients because of risk of prolonged encephalopathy. Unsedated transnasal endoscopy (T-EGD) is a new technique, which allows for unsedated examination because it is well tolerated. The aims of this study were to determine whether T-EGD is feasible for screening of cirrhotic patients for presence of EV and to compare the diagnostic yield of T-EGD with conventional endoscopy for detecting and grading of EV.
METHODS: Fifteen cirrhotics with no history of variceal bleeding, known EV, severe thrombocytopenia, or recurrent epistaxis were evaluated by unsedated T-EGD using a 5.3-mm outer diameter endoscope. Immediately afterward, a different endoscopist, blinded to T-EGD findings, performed sedated conventional endoscopy in standard fashion. The presence and size of EV, gastric varices, and other findings were recorded. Patient tolerance was also evaluated.
RESULTS: Both modalities detected EV in the same 10 and gastric varices in the same two patients and completely agreed on size of EV. No stigmata of recent variceal bleeding were noted. Average time for unsedated T-EGD was 5 min 6 s. All patients found both procedures acceptable overall, with no significant difference in choking, discomfort, and sore throat. One patient developed self-limited epistaxis after T-EGD.
CONCLUSIONS: 1) EV are accurately detected and graded by T-EGD in cirrhotic patients. 2) T-EGD is a safe and less costly screening alternative for EV in cirrhotic patients.
Author List
Saeian K, Staff D, Knox J, Binion D, Townsend W, Dua K, Shaker RAuthors
Kulwinder S. Dua MD Professor in the Medicine department at Medical College of WisconsinKia Saeian MD Professor in the Medicine department at Medical College of Wisconsin
Reza Shaker MD Assoc Provost, Sr Assoc Dean, Ctr Dir, Chief, Prof in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAged
Conscious Sedation
Endoscopy
Esophageal and Gastric Varices
Feasibility Studies
Female
Humans
Liver Cirrhosis
Male
Middle Aged
Nasal Cavity
Patient Satisfaction
Sensitivity and Specificity
Severity of Illness Index
