title: Performance characteristics of unsedated ultrathin video endoscopy in the assessment of the upper GI tract: systematic review and meta-analysis.
abstract: OBJECTIVE
  Reports on the performance of unsedated ultrathin endoscopy via the transnasal (uTNE) and transoral (uTOE) routes are conflicting. We aimed to estimate the technical success rate, patient preference, and acceptability of uTNE and uTOE alone and in comparison with conventional EGD (cEGD; with or without sedation).
  
  
  METHODS
  A systematic review and meta-analysis was performed on all primary studies reporting the outcomes of interest. Electronic databases (Cochrane library, MEDLINE, EMBASE) were searched on February 1, 2014.
  
  
  RESULTS
  Thirty-four studies met the inclusion criteria with 6659 patients in total. The pooled technical success rate was 94.0% for uTNE (95% confidence interval [CI], 91.6-95.8; 30 studies) and 97.8% for uTOE (95% CI, 95.6-98.9; 16 studies). The difference in proportion of success for uTNE compared with cEGD was -2.0% (95% CI, -4.0 to -1.0; 18 studies), but that difference was not significant when uTNE < 5.9 mm in diameter was used (-1.0%; 95% CI, -3.0 to .0; 9 studies). There was no significant difference in success rate between uTOE and cEGD (.0%; 95% CI, -1.0 to 2.0; 10 studies). The pooled difference in proportion of patients who preferred uTNE over cEGD was 63.0% (95% CI, 49.0-76.0; 10 studies), whereas preference for uTOE versus cEGD was not significantly different (38.0%; 95% CI, -4.0 to 80.0; 2 studies). Acceptability was high for both uTNE (85.2%; 95% CI, 79.1-89.9; 16 studies) and uTOE (88.7%; 95% CI, 82.4-92.9; 10 studies).
  
  
  CONCLUSIONS
  Technical success rate for uTNE < 5.9 mm is equivalent to cEGD. uTNE has high patient acceptability, with better patient preference, and therefore could be a useful alternative to cEGD for screening purposes. uTOE had a similar technical success rate but an equivocal preference to cEGD.
authors.affiliation: NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
authors.forename: Sarmed S
authors.initials: SS
authors.lastname: Sami
authors.affiliation: Molecular Gastroenterology, Institute of Biomedical and Clinical Sciences, University of Leeds, and Center for Digestive Diseases, St James University Hospital, Leeds, UK.
authors.forename: Venkataraman
authors.initials: V
authors.lastname: Subramanian
authors.affiliation: NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
authors.forename: Jacobo
authors.initials: J
authors.lastname: Ortiz-Fernández-Sordo
authors.affiliation: NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
authors.forename: Alhussain
authors.initials: A
authors.lastname: Saeed
authors.affiliation: Division of Gastroenterology, University of California San Diego, La Jolla, California, USA.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Singh
authors.affiliation: NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
authors.forename: Indra N
authors.initials: IN
authors.lastname: Guha
authors.affiliation: Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Prasad G
authors.initials: PG
authors.lastname: Iyer
authors.affiliation: NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
authors.forename: Krish
authors.initials: K
authors.lastname: Ragunath
mesh_terms: D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation*; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D057240:Patient Preference; D041742:Upper Gastrointestinal Tract / Q000473:pathology*; D014741:Video Recording