Sarmed S Sami1, Venkataraman Subramanian2, Jacobo Ortiz-Fernández-Sordo1, Alhussain Saeed1, Siddharth Singh3, Indra N Guha1, Prasad G Iyer4, Krish Ragunath1. 1. NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK. 2. Molecular Gastroenterology, Institute of Biomedical and Clinical Sciences, University of Leeds, and Center for Digestive Diseases, St James University Hospital, Leeds, UK. 3. Division of Gastroenterology, University of California San Diego, La Jolla, California, USA. 4. Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Abstract
BACKGROUND AND AIMS: Reports on the performance of unsedated ultrathin endoscopy via the transnasal (uTNE) and transoral (uTOE) routes are conflicting. We aimed to estimate the technical success rate, patient preference, and acceptability of uTNE and uTOE alone and in comparison with conventional EGD (cEGD; with or without sedation). METHODS: A systematic review and meta-analysis was performed on all primary studies reporting the outcomes of interest. Electronic databases (Cochrane library, MEDLINE, EMBASE) were searched on February 1, 2014. RESULTS: Thirty-four studies met the inclusion criteria with 6659 patients in total. The pooled technical success rate was 94.0% for uTNE (95% confidence interval [CI], 91.6-95.8; 30 studies) and 97.8% for uTOE (95% CI, 95.6-98.9; 16 studies). The difference in proportion of success for uTNE compared with cEGD was -2.0% (95% CI, -4.0 to -1.0; 18 studies), but that difference was not significant when uTNE < 5.9 mm in diameter was used (-1.0%; 95% CI, -3.0 to .0; 9 studies). There was no significant difference in success rate between uTOE and cEGD (.0%; 95% CI, -1.0 to 2.0; 10 studies). The pooled difference in proportion of patients who preferred uTNE over cEGD was 63.0% (95% CI, 49.0-76.0; 10 studies), whereas preference for uTOE versus cEGD was not significantly different (38.0%; 95% CI, -4.0 to 80.0; 2 studies). Acceptability was high for both uTNE (85.2%; 95% CI, 79.1-89.9; 16 studies) and uTOE (88.7%; 95% CI, 82.4-92.9; 10 studies). CONCLUSIONS: Technical success rate for uTNE < 5.9 mm is equivalent to cEGD. uTNE has high patient acceptability, with better patient preference, and therefore could be a useful alternative to cEGD for screening purposes. uTOE had a similar technical success rate but an equivocal preference to cEGD.
BACKGROUND AND AIMS: Reports on the performance of unsedated ultrathin endoscopy via the transnasal (uTNE) and transoral (uTOE) routes are conflicting. We aimed to estimate the technical success rate, patient preference, and acceptability of uTNE and uTOE alone and in comparison with conventional EGD (cEGD; with or without sedation). METHODS: A systematic review and meta-analysis was performed on all primary studies reporting the outcomes of interest. Electronic databases (Cochrane library, MEDLINE, EMBASE) were searched on February 1, 2014. RESULTS: Thirty-four studies met the inclusion criteria with 6659 patients in total. The pooled technical success rate was 94.0% for uTNE (95% confidence interval [CI], 91.6-95.8; 30 studies) and 97.8% for uTOE (95% CI, 95.6-98.9; 16 studies). The difference in proportion of success for uTNE compared with cEGD was -2.0% (95% CI, -4.0 to -1.0; 18 studies), but that difference was not significant when uTNE < 5.9 mm in diameter was used (-1.0%; 95% CI, -3.0 to .0; 9 studies). There was no significant difference in success rate between uTOE and cEGD (.0%; 95% CI, -1.0 to 2.0; 10 studies). The pooled difference in proportion of patients who preferred uTNE over cEGD was 63.0% (95% CI, 49.0-76.0; 10 studies), whereas preference for uTOE versus cEGD was not significantly different (38.0%; 95% CI, -4.0 to 80.0; 2 studies). Acceptability was high for both uTNE (85.2%; 95% CI, 79.1-89.9; 16 studies) and uTOE (88.7%; 95% CI, 82.4-92.9; 10 studies). CONCLUSIONS: Technical success rate for uTNE < 5.9 mm is equivalent to cEGD. uTNE has high patient acceptability, with better patient preference, and therefore could be a useful alternative to cEGD for screening purposes. uTOE had a similar technical success rate but an equivocal preference to cEGD.
Authors: Christopher H Blevins; Jason S Egginton; Nilay D Shah; Michele L Johnson; Prasad G Iyer Journal: J Clin Gastroenterol Date: 2018 Nov/Dec Impact factor: 3.062
Authors: Sarmed S Sami; Prasad G Iyer; Prachi Pophali; Magnus Halland; Massimiliano di Pietro; Jacobo Ortiz-Fernandez-Sordo; Jonathan R White; Michele Johnson; Indra Neil Guha; Rebecca C Fitzgerald; Krish Ragunath Journal: Clin Gastroenterol Hepatol Date: 2018-08-03 Impact factor: 11.382
Authors: Nicholas R Crews; Michele L Johnson; Cathy D Schleck; Felicity T Enders; Louis-Michel Wongkeesong; Kenneth K Wang; David A Katzka; Prasad G Iyer Journal: Dig Dis Sci Date: 2016-08-10 Impact factor: 3.199
Authors: Nicholas R Crews; Emmanuel C Gorospe; Michele L Johnson; Louis-Michel Wong Kee Song; David A Katzka; Prasad G Iyer Journal: Endosc Int Open Date: 2017-05