"Skinny Scope” for Less-Risky Esophagus Screening

A new study reports that screening patients with chronic heartburn or pre-cancer of the esophagus in an office setting with small-caliber endoscopy is as accurate but less expensive and less risky than a traditional sedated screening in a procedure room.

Researchers at the Oregon Health & Science University (OHSU, Portland, USA) Digestive Health Center enrolled 134 patients with long-standing histories of gastroesophageal reflux disease (GERD) symptoms and acid-reducing medication in a randomized, cross-over trial, with 98% of the subjects successfully completing unsedated small-caliber endoscopy, using the so-called "skinny scope” in an office setting. Patients inhaled a topical anesthetic that numbed their nasal passages and throat. The clinician then passed the 4.9 mm caliber endoscope through the nose, pharynx, and throat.

More than 70% of the study participants said they would choose the unsedated skinny scope over conventional sedated upper endoscopy. They listed a number of reasons for preferring the skinny scope, including not having to undergo anesthesia, not missing a day of work, not having to arrange for transportation to and from home, and the ability to watch the entire procedure in real time on a color monitor and receive immediate feedback from the clinician. The prevalence of Barrett's esophagus discovered by both approaches was equal, and there were no undetected cases of cancer. The findings were published in the December 2006 edition of the American Journal of Gastroenterology.

"It's a more personal approach and represents the potential to eliminate the infrastructure and costs required for intravenous sedation. It's also more immediate. As soon as you're done, you can tell the patient what you've found,” said lead author Blair A. Jobe, M.D., a surgeon in the OHSU Digestive Health Center and member of the OHSU Cancer Institute.

Barrett's esophagus refers to an abnormal change (metaplasia) in the cells of the lower end of the esophagus thought to be caused by damage from GERD. Barrett's esophagus is found in about 10% of patients who seek medical care, and is considered to be a pre-malignant condition associated with an increased risk of esophageal cancer.



Related Links:
Oregon Health & Science University