title: Randomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barrett's esophagus.
abstract: 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.
  
  
  METHODS
  Prospective, randomized, crossover study.
  
  
  METHODS
  Single, tertiary-care referral center.
  
  
  METHODS
  This study enrolled consecutive patients with BE or those referred for diagnostic assessment.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  TNE is an accurate and well-tolerated method for diagnosing BE compared with SE. TNE warrants further evaluation as a screening tool for BE.
authors.affiliation: MRC Cancer Cell Unit, Hutchison-MRC Research Centre, Cambridge, United Kingdom.
authors.forename: M Kareem
authors.initials: MK
authors.lastname: Shariff
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Bird-Lieberman
authors.forename: Maria
authors.initials: M
authors.lastname: O'Donovan
authors.forename: Zarah
authors.initials: Z
authors.lastname: Abdullahi
authors.forename: Xinxue
authors.initials: X
authors.lastname: Liu
authors.forename: Jane
authors.initials: J
authors.lastname: Blazeby
authors.forename: Rebecca
authors.initials: R
authors.lastname: Fitzgerald
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis / Q000473:pathology*; D001706:Biopsy; D018592:Cross-Over Studies; D004945:Esophagoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000175:diagnosis / Q000473:pathology*; D008875:Middle Aged; D057240:Patient Preference; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013732:Test Anxiety Scale; D055815:Young Adult