title: Office-based unsedated small-caliber endoscopy is equivalent to conventional sedated endoscopy in screening and surveillance for Barrett's esophagus: a randomized and blinded comparison.
abstract: OBJECTIVE
  A major limitation to screening and surveillance of Barrett's esophagus is the complexity, expense, and risk associated with sedation for upper endoscopy. This study examines the feasibility, accuracy, and patient acceptability of office-based unsedated endoscopy as an alternative.
  
  
  METHODS
  Of 274 eligible adults scheduled for endoscopic screening for gastroesophageal reflux symptoms or surveillance of Barrett's esophagus at a tertiary care center, 121 underwent unsedated small-caliber endoscopy and conventional endoscopy in a randomized crossover study. The two procedures were compared with regard to histological detection of Barrett's esophagus and dysplasia and biopsy size. Patients answered questionnaires assessing the tolerability of the procedures.
  
  
  RESULTS
  The prevalence of Barrett's esophagus was 26% using conventional endoscopy and 30% using unsedated endoscopy (P= 0.503). The level of agreement between the two approaches was "moderate" (kappa= 0.591). Each modality detected four cases of low-grade dysplasia with concordance on one case. The tissue samples collected with unsedated endoscopy were smaller than with conventional endoscopy (P < 0.001). The majority of subjects rated their experience with both procedures as being well tolerated with minimal or no difficulty. When asked which procedure they would prefer in the future, 71% (81/114) chose unsedated small-caliber endoscopy.
  
  
  CONCLUSIONS
  Office-based unsedated small-caliber endoscopy is technically feasible, well tolerated, and accurate in screening for Barrett's esophagus, despite yielding a smaller biopsy specimen. This approach bears the potential to eliminate the infrastructure and cost required for intravenous sedation in this application.
authors.affiliation: Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: Blair A
authors.initials: BA
authors.lastname: Jobe
authors.forename: John G
authors.initials: JG
authors.lastname: Hunter
authors.forename: Eugene Y
authors.initials: EY
authors.lastname: Chang
authors.forename: Charles Y
authors.initials: CY
authors.lastname: Kim
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Eisen
authors.forename: Jedediah D
authors.initials: JD
authors.lastname: Robinson
authors.forename: Brian S
authors.initials: BS
authors.lastname: Diggs
authors.forename: Robert W
authors.initials: RW
authors.lastname: O'Rourke
authors.forename: Anne E
authors.initials: AE
authors.lastname: Rader
authors.forename: Paul
authors.initials: P
authors.lastname: Schipper
authors.forename: David A
authors.initials: DA
authors.lastname: Sauer
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Peters
authors.forename: David A
authors.initials: DA
authors.lastname: Lieberman
authors.forename: Cynthia D
authors.initials: CD
authors.lastname: Morris
mesh_terms: D000368:Aged; D000556:Ambulatory Surgical Procedures; D001471:Barrett Esophagus / Q000473:pathology*; D016292:Procedural Sedation; D018592:Cross-Over Studies; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005764:Gastroesophageal Reflux / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D015203:Reproducibility of Results; D016037:Single-Blind Method