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Randomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barrett 's esophagus . 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 ( R ( 2 ) = 0.97 ; P < .001 ) . The sensitivity and specificity for detecting intestinal metaplasia by TNE compared with those by SE was 0.91 and 1.00 , respectively . The mean ( ± standard deviation ) post-endoscopy Spielberger State-Trait Anxiety Inventory short-form score for TNE ( 30.0 ± 1.10 standard error of the mean [ SEM ] ) was lower than that for SE ( 30.7 ± 1.29 SEM ) , ( P = .054 ) . The visual analogue scale scores were no different ( P = .07 ) . The majority of patients ( 59 % ) expressed a preference for TNE . LIMITATIONS This is a small study , with limited generalizability , a high prevalence of patients with BE , differential drop-out between the two procedures , and use of sedation . CONCLUSION TNE is an accurate and well-tolerated method for diagnosing BE compared with SE . TNE warrants further evaluation as a screening tool for BE .
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Intervention_Physical
transnasal endoscopy with that of standard endoscopy
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Intervention_Surgical
Unsedated transnasal endoscopy ( TNE )
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Intervention_Control
standard endoscopy ( SE )
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Intervention_Surgical
TNE
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Intervention_Control
SE .
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Intervention_Surgical
TNE
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Intervention_Control
SE
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Intervention_Surgical
TNE
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Intervention_Control
SE .
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Intervention_Surgical
TNE
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Intervention_Control
SE
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Intervention_Surgical
TNE
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Intervention_Surgical
TNE
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Intervention_Control
SE
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Intervention_Surgical
TNE
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Intervention_Control
SE
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Outcome_Other
efficacy
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Outcome_Other
sensitivity , specificity ,
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Outcome_Physical
and
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Outcome_Other
acceptability
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Outcome_Mental
Spielberger State-Trait Anxiety Inventory short-form questionnaires
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Outcome_Other
a visual analogue scale
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Outcome_Other
single question addressing preference for endoscopy type
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Outcome_Other
Diagnostic accuracy and tolerability
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Outcome_Physical
BE median length
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Outcome_Physical
sensitivity and specificity
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Participant_Condition
Barrett 's esophagus ( BE ) .
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Participant_Condition
BE
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Participant_Sample-size
95 patients
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Participant_Sample-size
82