title: Pilot randomized crossover study comparing the efficacy of transnasal disposable endosheath with standard endoscopy to detect Barrett's esophagus.
abstract: OBJECTIVE
  The transnasal endosheath endoscope is a new disposable technology with potential applicability to the primary care setting. The aim of this study was to evaluate the efficacy of transnasal endosheath endoscopy (TEE) for the detection of Barrett's esophagus, by comparing the diagnostic accuracy of TEE with that of standard endoscopy.
  
  
  METHODS
  This was a prospective, randomized, crossover study performed in a single tertiary referral center. Consecutive patients undergoing surveillance for Barrett's esophagus or referred for diagnostic assessment were recruited. All patients were randomized to undergo TEE followed by standard endoscopy or the reverse. Endoscopy experiences and patient preferences were evaluated using a questionnaire. Endoscopic and histologic diagnosis of Barrett's esophagus, and optical image quality of both endoscopic procedures, were compared.
  
  
  RESULTS
  A total of 21 of 25 patients completed the study. TEE had sensitivity and specificity of 100 % for an endoscopic diagnosis of Barrett's esophagus, and of 66.7 % and 100 %, respectively, for the histologic diagnosis of Barrett's esophagus. The mean optical quality of standard endoscopy was significantly better than that of TEE (7.11 ± 0.42 vs. 4.06 ± 0.27; P < 0.0001). However, following endoscopy, patients reported a significantly better experience with TEE compared with standard endoscopy (7.05 ± 0.49 vs. 4.35 ± 0.53; P = 0.0006), with 60 % preferring TEE and 25 % preferring sedated standard endoscopy.
  
  
  CONCLUSIONS
  In this study, TEE had equal accuracy for an endoscopic diagnosis of Barrett's esophagus compared with standard endoscopy, at the expense of reduced image quality and a lower yield of intestinal metaplasia on biopsy. TEE was better tolerated and preferred by patients. Hence, TEE needs further evaluation in primary care as an initial diagnostic tool.
authors.affiliation: MRC Cancer Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom.
authors.forename: Mohammed K
authors.initials: MK
authors.lastname: Shariff
authors.affiliation: MRC Cancer Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom.
authors.forename: Sibu
authors.initials: S
authors.lastname: Varghese
authors.affiliation: MRC Cancer Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom.
authors.forename: Maria
authors.initials: M
authors.lastname: O'Donovan
authors.affiliation: MRC Cancer Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom.
authors.forename: Zarah
authors.initials: Z
authors.lastname: Abdullahi
authors.affiliation: MRC Cancer Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom.
authors.forename: Xinxue
authors.initials: X
authors.lastname: Liu
authors.affiliation: MRC Cancer Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom.
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Fitzgerald
authors.affiliation: MRC Cancer Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: di Pietro
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology*; D001706:Biopsy / Q000379:methods; D018592:Cross-Over Studies; D004209:Disposable Equipment; D004867:Equipment Design; D004945:Esophagoscopy / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation*; D009666:Nose; D057240:Patient Preference; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D055815:Young Adult