The detection of oesophageal varices using a novel, disposable, probe-based transnasal endoscope: a prospective diagnostic pilot study

• Published in: Liver international 2016-11, Vol.36 (11), p.1639-1648
• Main Authors: Sami, Sarmed S., Ragunath, Krish, Wilkes, Emilie A., James, Martin, Mansilla-Vivar, Rodrigo, Ortiz-Fernández-Sordo, Jacobo, White, Jonathan, Khanna, Amardeep, Coletta, Marina, Samuel, Sunil, Aithal, Guruprasad P., Guha, Indra Neil
• Format: Article
• Language: English
• Subjects: Aged; Disposable Equipment; endoscopy; Endoscopy, Digestive System; Esophageal and Gastric Varices - diagnosis; Esophagoscopy - instrumentation; Esophagoscopy - methods; Female; Humans; Liver Cirrhosis - complications; Male; Middle Aged; Pilot Projects; Prospective Studies; screening; Sensitivity and Specificity; Tertiary Care Centers; transnasal; United Kingdom; varices
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.13152

Background & Aims Screening for oesophageal varices (OV) using conventional oesophagogastroduodenoscopy (C‐OGD) is invasive and requires costly monitoring, recovery, and decontamination facilities. We aimed to evaluate the technical feasibility, acceptability and accuracy of a novel, portable and disposable office‐based transnasal endoscope (EG Scan™) compared to C‐OGD as the reference standard. Methods This was a prospective cohort study. Consecutive adult patients with cirrhosis were invited to participate. All subjects underwent the two procedures on the same day performed by two endoscopists in a blinded design. Patients completed preference and validated tolerability (10‐point visual analogue scale (VAS)) questionnaires on day 0 and day 14 post procedures. Results Forty‐five of 50 patients (90%) completed both interventions. Mean age was 59 years and OV prevalence was 49%. Patients reported higher preference (percentage) and better experience (mean VAS) with EG Scan compared to C‐OGD on day 0 (76.5% vs. 23.5%, P < 0.001; 7.8 vs. 6.8, P = 0.058, respectively) and day 14 (77.8% vs. 22.2%, P < 0.001; 7.0 vs. 5.5, P = 0.0013 respectively). Sensitivity and specificity of the EG Scan for the diagnosis of any size OV were 0.82 (95% confidence interval (CI) 0.60–0.95), and 0.78 (95% CI 0.56–0.93) respectively. Corresponding values for the diagnosis of clinically significant (medium/large) OV were 0.92 (95% CI 0.62–1.0), 0.97 (95% CI 0.84–1.0) respectively. No serious adverse events occurred. Conclusions EG Scan accuracy was higher for the diagnosis of medium/large OV compared to any size OV. Patients' preference and overall experience of the EG Scan was favourable compared to C‐OGD 14 days after procedures.