title: Unsedated transnasal endoscopy accurately detects Barrett's metaplasia and dysplasia.
abstract: BACKGROUND
  Unsedated transnasal upper endoscopy has a diagnostic yield comparable with that of sedated conventional upper endoscopy. The ability of transnasal upper endoscopy to detect Barrett's metaplasia or dysplastic change has not been systematically evaluated. The aim of this study was to assess the feasibility of transnasal upper endoscopy for surveillance of patients with Barrett's esophagus and to evaluate its histopathologic yield for Barrett's metaplasia and dysplasia.
  
  
  METHODS
  Thirty-two patients with Barrett's esophagus were evaluated with conventional upper endoscopy and transnasal upper endoscopy. An effort was made to recruit patients known to have dysplasia. Quadrantic biopsy specimens were taken with standard (conventional upper endoscopy) and pediatric (transnasal upper endoscopy) biopsy forceps at procedures performed at least 1 week apart. Two blinded pathologists evaluated the specimens.
  
  
  RESULTS
  Transnasal upper endoscopy detected Barrett's metaplasia histopathologically in 31 of 32 patients. Level of agreement for presence of dysplasia in biopsy specimens obtained between conventional upper endoscopy and transnasal upper endoscopy was excellent (k = 0.79). Interobserver agreement for dysplasia in specimens obtained by conventional upper endoscopy (k = 0.61) and by transnasal upper endoscopy (k = 0.61) were similar. Intraobserver agreement between conventional upper endoscopy and transnasal upper endoscopy biopsy specimens for dysplasia by pathologist 1 (k = 0.73) and pathologist 2 (k = 0.75) were also similar. No significant adverse effects were noted.
  
  
  CONCLUSIONS
  Transnasal upper endoscopy is feasible and accurate for identification and histopathologic confirmation of Barrett's metaplasia with a histopathologic yield for dysplasia comparable with conventional upper endoscopy.
authors.affiliation: MCW Dysphagia Institute, Division of Gastroenterology and Hepatology and Department of Pathology, and the Medical College of Wisconsin and C.J. Zablocki V.A. Medical Center, Milwaukee, Wisconsin 53226, USA.
authors.forename: Kia
authors.initials: K
authors.lastname: Saeian
authors.forename: David M
authors.initials: DM
authors.lastname: Staff
authors.forename: Sotirios
authors.initials: S
authors.lastname: Vasilopoulos
authors.forename: William F
authors.initials: WF
authors.lastname: Townsend
authors.forename: Urias A
authors.initials: UA
authors.lastname: Almagro
authors.forename: Richard A
authors.initials: RA
authors.lastname: Komorowski
authors.forename: Hongyung
authors.initials: H
authors.lastname: Choi
authors.forename: Reza
authors.initials: R
authors.lastname: Shaker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology*; D001706:Biopsy / Q000295:instrumentation / Q000379:methods; D004938:Esophageal Neoplasms / Q000473:pathology*; D004943:Esophagogastric Junction / Q000473:pathology*; D020701:Esophagoscopes; D004945:Esophagoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008297:Male; D008679:Metaplasia / Q000473:pathology; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D006993:Hypnotics and Sedatives