Randomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barrett's esophagus

Abstract

Background: Unsedated transnasal endoscopy (TNE) may be safer and less expensive than standard endoscopy (SE) for detecting Barrett's esophagus (BE). Emerging technologies require robust evaluation before routine use. Objective: To evaluate the sensitivity, specificity, and acceptability of TNE in diagnosing BE compared with those of SE. Design: Prospective, randomized, crossover study. Setting: Single, tertiary-care referral center. Patients: This study enrolled consecutive patients with BE or those referred for diagnostic assessment. Intervention: All patients underwent TNE followed by SE or the reverse. Spielberger State-Trait Anxiety Inventory short-form questionnaires, a visual analogue scale, and a single question addressing preference for endoscopy type were administered. Main Outcome Measurements: Diagnostic accuracy and tolerability of TNE were compared with those of SE. Results: Of 95 patients randomized, 82 completed the study. We correctly diagnosed 48 of 49 BE cases by TNE for endoscopic findings of columnar lined esophagus compared with the criterion standard, SE, giving a sensitivity and specificity of 0.98 and 1.00, respectively. The BE median length was 3 cm (interquartile range [IQR] 1-5 cm) with SE and 3 cm (IQR 2-4 cm) with TNE, giving high correlations between the two modalities (R2 = 0.97; P