title: Comparative acceptability of transnasal esophagoscopy and esophageal capsule esophagoscopy: a randomized, controlled trial in veterans.
abstract: BACKGROUND
  EGD screening for Barrett's esophagus (BE) is costly, with insufficient evidence to support its effectiveness.
  
  
  OBJECTIVE
  To compare acceptance and tolerability of 2 novel, office-based, endoscopic screening techniques done on nonsedated patients.
  
  
  METHODS
  Randomized block study design with allocation concealment.
  
  
  METHODS
  Outpatient clinic setting at a Veterans Affairs medical center.
  
  
  METHODS
  A total of 184 veterans with or without GERD symptoms.
  
  
  METHODS
  Transnasal esophagoscopy (TNE) or esophageal capsule esophagoscopy (ECE).
  
  
  METHODS
  Acceptance and tolerability of TNE and ECE and effectiveness of BE screening.
  
  
  RESULTS
  Esophageal screening was accepted by 184 of 1210 (15.2%) veterans. The majority were men (96%) and African American (58%), with a mean (± standard deviation) age of 58.9 (± 8.1) years. Five TNE participants (5%) and 2 ECE participants (2%) refused the assigned procedure after randomization (P = .25). Eleven patients (12.6%) randomized to TNE crossed the minimal clinically important threshold for overall procedure tolerability, as opposed to no patients randomized to ECE (P = .001). Effectiveness of BE screening was not significantly different in both procedures (TNE vs ECE = 3.2% vs 5.4%; P = .47). Overall, BE was present in 8 of 75 white participants (10.6%) and in 0 of 107 African American participants (P < .001).
  
  
  CONCLUSIONS
  The general veteran population may not reflect the screening population for BE.
  
  
  CONCLUSIONS
  Despite a small proportion of veterans expressing interest in esophageal screening, both TNE and ECE were feasible in the outpatient clinic setting and were accepted by >95% of participants who did express an interest. Screening was effective only in white participants. Moderate differences in tolerability between TNE and ECE notwithstanding, cost considerations along with availability of equipment and trained personnel should guide the modality to be used for BE screening.
authors: Department of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA; Digestive Health Institute, University Hospitals Case Medical Center, Cleveland, Ohio, USA; Department of Gastroenterology, Case Western Reserve University, Cleveland, Ohio, USA.
authors: Amitabh
authors: A
authors: Chak
authors: Department of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA.
authors: Bronia M
authors: BM
authors: Alashkar
authors: Department of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA; Digestive Health Institute, University Hospitals Case Medical Center, Cleveland, Ohio, USA; Department of Gastroenterology, Case Western Reserve University, Cleveland, Ohio, USA.
authors: Gerard A
authors: GA
authors: Isenberg
authors: Department of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA; Digestive Health Institute, University Hospitals Case Medical Center, Cleveland, Ohio, USA; Department of Gastroenterology, Case Western Reserve University, Cleveland, Ohio, USA.
authors: Apoorva K
authors: AK
authors: Chandar
authors: Department of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA; Digestive Health Institute, University Hospitals Case Medical Center, Cleveland, Ohio, USA; Department of Gastroenterology, Case Western Reserve University, Cleveland, Ohio, USA.
authors: Katarina B
authors: KB
authors: Greer
authors: Department of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA; Digestive Health Institute, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
authors: Ashley
authors: A
authors: Hepner
authors: Department of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA.
authors: Richard D
authors: RD
authors: Pulice
authors: Department of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA.
authors: Srikrishna
authors: S
authors: Vemana
authors: Department of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA; Digestive Health Institute, University Hospitals Case Medical Center, Cleveland, Ohio, USA; Department of Gastroenterology, Case Western Reserve University, Cleveland, Ohio, USA.
authors: Yngve
authors: Y
authors: Falck-Ytter
authors: Department of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA; Digestive Health Institute, University Hospitals Case Medical Center, Cleveland, Ohio, USA; Department of Gastroenterology, Case Western Reserve University, Cleveland, Ohio, USA.
authors: Ashley L
authors: AL
authors: Faulx
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000209:etiology; D053704:Capsule Endoscopy / Q000379:methods*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods; D010342:Patient Acceptance of Health Care; D014728:Veterans