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Endoscopy 2011; 43(8): 649-656
DOI: 10.1055/s-0030-1256474
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Comparison of transnasal small-caliber vs. peroral conventional esophagogastroduodenoscopy for evaluating varices in unsedated cirrhotic patients

W.  H.  Choe1 , J.  H.  Kim1 , 2 , S.  Y.  Ko1 , S.  Y.  Kwon1 , B.  K.  Kim1 , K.  H.  Rhee1 , T.  H.  Seo1 , T.  Y.  Lee1 , S.  N.  Hong1 , 2 , S.-Y.  Lee1 , I.  K.  Sung1 , H.  S.  Park1 , C.  S.  Shim1
  • 1Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea
  • 2Medical Immunology Center, Konkuk University, Seoul, Korea
Further Information

Publication History

submitted 13 March 2010

accepted after revision 6 March 2011

Publication Date:
09 June 2011 (online)

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Commentaire de travail de W. H. Choe et al., pp. 649Endoscopy 2011; 43(08): 931-931
DOI: 10.1055/s-0031-1291775

Background and study aims: We aimed to evaluate the accuracy of transnasal small-caliber esophagogastroduodenoscopy (TNSC-EGD) compared with peroral conventional EGD (POC-EGD) for evaluating varices in unsedated patients with liver cirrhosis. The success rate, safety, endoscopist satisfaction, and patient tolerability of TNSC-EGD were also addressed.

Patients and methods: One hundred patients with liver cirrhosis participated in this randomized crossover trial, and 84 subjects completed both procedures. Of the 84 patients, 28 had marked bleeding diathesis (platelet count ≤ 50 000/mm3 and/or prothrombin time ≥ 1.7 INR). Endoscopists and patients answered questionnaires using a 100-mm visual analog scale about, respectively, their satisfaction and their tolerance of the procedure.

Results: The success rate of TNSC-EGD was comparable to that of POC-EGD (96 % vs. 99 %). Nasal mucosal hemorrhages induced by TNSC-EGD occurred in 5 patients (6 %), but were easily controlled. Compared to the POC-EGD reference test, diagnostic accuracies of TNSC-EGD for detecting esophageal varices, gastric varices, and red color signs were 98 %, 98 %, and 96 %, respectively. Concordance rates on grading esophageal varices and gastric varices were excellent at 93 % (κ = 0.85) and 96 % (κ = 0.87). Endoscopist satisfaction was not significantly different between TNSC-EGD and POC-EGD, whereas patient tolerance of TNSC-EGD was significantly greater than that of POC-EGD (79.0 ± 14.4 vs. 69.5 ± 16.1; P = 0.001).

Conclusion: TNSC-EGD without sedation was found to be feasible, safe, and accurate for evaluating esophageal varices, gastric varices, and red color signs in patients with cirrhosis – even in those with marked bleeding diathesis. Furthermore, it was significantly better tolerated by patients, without altering endoscopist satisfaction. Our findings indicate that TNSC-EGD without sedation might be viewed as a potential alternative to POC-EGD for evaluation of varices.

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J. H. KimMD 

Department of Internal Medicine
Konkuk University School of Medicine
Medical Immunology Center

4-12 Hwayang-dong
Gwangjin-gu
Seoul
143-729 Korea

Fax: +82-2-20305029

Email: sefamily@kuh.ac.kr

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