title: Comparison of transnasal small-caliber vs. peroral conventional esophagogastroduodenoscopy for evaluating varices in unsedated cirrhotic patients.
abstract: OBJECTIVE
  We aimed to evaluate the accuracy of transnasal small-caliber esophagogastroduodenoscopy (TNSC-EGD) compared with peroral conventional EGD (POC-EGD) for evaluating varices in unsedated patients with liver cirrhosis. The success rate, safety, endoscopist satisfaction, and patient tolerability of TNSC-EGD were also addressed.
  
  
  METHODS
  One hundred patients with liver cirrhosis participated in this randomized crossover trial, and 84 subjects completed both procedures. Of the 84 patients, 28 had marked bleeding diathesis (platelet count ≤ 50000/mm (3) and/or prothrombin time ≥ 1.7 INR). Endoscopists and patients answered questionnaires using a 100-mm visual analog scale about, respectively, their satisfaction and their tolerance of the procedure.
  
  
  RESULTS
  The success rate of TNSC-EGD was comparable to that of POC-EGD (96% vs. 99%). Nasal mucosal hemorrhages induced by TNSC-EGD occurred in 5 patients (6%), but were easily controlled. Compared to the POC-EGD reference test, diagnostic accuracies of TNSC-EGD for detecting esophageal varices, gastric varices, and red color signs were 98%, 98%, and 96%, respectively. Concordance rates on grading esophageal varices and gastric varices were excellent at 93% (κ  =  0.85) and 96% (κ  = 0.87). Endoscopist satisfaction was not significantly different between TNSC-EGD and POC-EGD, whereas patient tolerance of TNSC-EGD was significantly greater than that of POC-EGD (79.0 ± 14.4 vs. 69.5 ± 16.1; P  = 0.001).
  
  
  CONCLUSIONS
  TNSC-EGD without sedation was found to be feasible, safe, and accurate for evaluating esophageal varices, gastric varices, and red color signs in patients with cirrhosis - even in those with marked bleeding diathesis. Furthermore, it was significantly better tolerated by patients, without altering endoscopist satisfaction. Our findings indicate that TNSC-EGD without sedation might be viewed as a potential alternative to POC-EGD for evaluation of varices.
authors.affiliation: Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea.
authors.forename: W H
authors.initials: WH
authors.lastname: Choe
authors.forename: J H
authors.initials: JH
authors.lastname: Kim
authors.forename: S Y
authors.initials: SY
authors.lastname: Ko
authors.forename: S Y
authors.initials: SY
authors.lastname: Kwon
authors.forename: B K
authors.initials: BK
authors.lastname: Kim
authors.forename: K H
authors.initials: KH
authors.lastname: Rhee
authors.forename: T H
authors.initials: TH
authors.lastname: Seo
authors.forename: T Y
authors.initials: TY
authors.lastname: Lee
authors.forename: S N
authors.initials: SN
authors.lastname: Hong
authors.forename: S-Y
authors.initials: SY
authors.lastname: Lee
authors.forename: I K
authors.initials: IK
authors.lastname: Sung
authors.forename: H S
authors.initials: HS
authors.lastname: Park
authors.forename: C S
authors.initials: CS
authors.lastname: Shim
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D016292:Procedural Sedation; D018592:Cross-Over Studies; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods*; D004844:Epistaxis / Q000209:etiology; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000293:injuries; D057240:Patient Preference; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity