Original articleClinical endoscopyRandomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barrett's esophagus
Section snippets
Setting and patients
This study was performed in Cambridge University Hospital National Health Service Foundation Trust within a dedicated research endoscopy unit. All procedures were performed by two experienced endoscopists (E. L. B.-L., M.K.S.) accredited in SE and fully trained in TNE. The study was approved by the Cambridgeshire 2 research ethics committee, Cambridge, United Kingdom, and all patients provided written informed consent.
Two groups of consecutive patients aged >18 years were eligible for this
Enrollment and participants
Between March 2009 and September 2010, 382 patients were eligible for the study and were invited to participate. Of the 382 patients, 95 (25%) consented and were enrolled to undergo SE (n = 51) or TNE (n = 44), of which 13 withdrew (10 after SE and 3 after TNE). Therefore, 82 of 95 (86%) completed the study (Fig. 1). Baseline characteristics of the two groups were similar (Table 1).
Endoscopic and histologic outcomes
As shown in Table 2, 49 participants (52%) had an endoscopic diagnosis of BE on SE, and TNE detected 48 of them.
Discussion
This randomized, crossover, efficacy trial shows that TNE has a sensitivity and specificity of 0.98 and 1.00 for endoscopic detection of BE and 0.91 and 1.00 for detection of columnar lined esophagus with IM, confirmed on biopsy, with almost perfect agreement between the two procedures (K = 0.94; 95% CI, 0.85-1.00). Both procedures also accurately measured length of BE (R2 = 0.97; P < .001). Despite the smaller biopsy size with TNE, the pick-up rate for IM was identical to that of SE. Patients
Acknowledgments
We thank the participants of the study and Imotech Medical Ltd for loan of their endoscopes. We are grateful to the staff of Addenbrookes Centre for Clinical Investigation, Addenbrookes Treatment Centre Endoscopy and tissue bank, including Bev Spencer and Roberto Cayado-Lopez. We would like to thank Sarah Vowler, from the Cambridge Research Institute, for her initial advice on sample size. We are very grateful to Mimi McCord and the McCord Foundation for funding.
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DISCLOSURE: This study was supported by funding from the McCord Foundation (to R.F.), Cambridge Experimental Cancer Medicine Centre, NIHR Cambridge Biomedical Research Centre, and a core grant from the Medical Research Council. All funding was awarded to R.F. No other financial relationships relevant to this publication were disclosed.
If you would like to chat with an author of this article, you may contact Dr Fitzgerald at [email protected].
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Drs Shariff and Bird-Lieberman contributed equally to this article.