Patients equally prefer sedated and unsedated Barrett esophagus screening

Last Updated: 2018-02-16

By Reuters Staff

NEW YORK (Reuters Health) - Patients are as likely to prefer unsedated transnasal endoscopy (uTNE) as sedated esophagogastroduodenoscopy (sEGD) for Barrett esophagus (BE) screening, according to findings published in the Journal of Clinical Gastroenterology.

"Given acceptable tolerability, uTNE may be a viable alternative to sEGD for BE screening," Dr. Prasad G. Iyer of the Mayo Clinic in Rochester, Minnesota, and colleagues conclude in their January 23 report.

BE, a complication of gastroesophageal reflux disease (GERD), is a precursor of esophageal adenocarcinoma (EAC). Patients typically undergo sEGD to assess complications of and symptoms of GERD. While screening for BE could aid in early detection of dysplasia before EAC, the authors note, the lack of a screening test that does not require sedation limits more widespread BE screening.

While sEGD is less painful, patients tolerate both methods well, with less sympathetic activation during uTNE, Dr. Iyer and his team write.

They conducted a comparative effectiveness trial, randomizing 201 patients without BE to receive in-clinic uTNE (71 patients), mobile-based uTNE (59) or sEGD (59). A valuation method, called waiting trade-off (WTO), was used to assess patient preferences, including short-term health-related quality of life - rather than a typical rating-scale method.

With the WTO method, patients showed similar preferences for sEGD and uTNE, both clinic- and mobile-based. Tolerability was significantly better for sEGD, but patients rated both types of uTNE as acceptable. All patients who underwent sEGD, and 84% of those who had uTNE, said they would have the procedure again.

In a previously published randomized trial, the researchers found that uTNE and sEGD had similar clinical effectiveness, safety, diagnostic yield and quality. "However," they note, "uTNE continues to be underutilized for BE screening due to perceived patient and provider lack of preference, despite randomized studies showing comparable patient tolerance between both sedated EGD and unsedated TNE."

They conclude: "When combined with lower direct and indirect costs and comparable clinical effectiveness, the rationale for the use of unsedated minimally invasive tools for BE is further strengthened."

Dr. Iyer was not available for an interview by press time.

SOURCE: http://bit.ly/2EmHESP

J Clin Gastroenterol 2018.