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随机交叉研究比较经鼻内镜与标准内镜检测Barrett食管的效果

发布日期:2014-1-29 12:40:37 文章来源:GIE 作者次数:1264

     随机交叉研究比较经鼻内镜与标准内镜检测Barrett食管的效果

    背景

    对检查Barrett食管(BE)来说,镇静下经鼻内镜检查TNE)可能会比标准内镜检查(SE)更安全而且便宜。常规使用前,新兴技术需要更完善的评估。

    目的

    评估比较TNESE诊断BE的灵敏度、特异性和可接受性。

    设计

    此研究为一项前瞻性随机交叉研究。

    环境

    单个三级医疗转诊中心。

    患者

    本研究纳入连续BE患者或参与诊断性评估的患者。

    干预

    所有患者均接受TNE,之后接受SE,或者先接受SE,后接受TNE。实施Spielberger状态-特质焦虑量表短式问卷,这种问卷是一种视觉类比量表,也是说明内镜类型优先选择的单选问题。

    主要测量指标

    比较TNESE的诊断准确性和耐受性。

    结果

    95例随机化患者中,82例患者完成了本研究。为进行内镜下柱状上皮食管的检查,我们采用TNE49BE病例中的48例进行了正确诊断,并与标准内镜(SE进行了)比较,结果其敏感性与特异性分别为0.981.00。采用SEBE中位长度为3 cm(四分范围(IQR)为1-5 cm),而采用TNEBE中位长度为3 cmIQR2-4 cm),两种治疗方式之间的相关性较高(R2 = 0.97P < 0.001)。与SE相比,TNE检测肠上皮化生的敏感性和特异性分别为0.911.00。采用TNE比采用SE所得平均(±标准偏差)内镜检查后Spielberger状态 - 特质焦虑量表短式问卷得分较低,分别为30.0 ± 1.10 (平均标准误差[SEM]) 30.7 ± 1.29 SEMP = 0.054。视觉类比量表较相似(P = 0.07)。多数患者(59%)倾向于选择TNE

    局限性

    这是一个小型研究,普遍性有限,BE患者患病率高,两种诊断手术之间的退出方法(drop-out不同,且使用镇静手段。

    结论

    SE相比,TNE是一种准确的且具有良好耐受性的诊断BE的方法。TNE作为BE筛选工具需要进一步评估。

    缩写词BE,巴雷特食管;CI,置信区间;IM,肠上皮化生;SE,标准内镜检查;STAISpielberger状态 - 特质焦虑量表;TNE,经鼻内镜。

     


     

    Randomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barretts esophagus

    Background

    Unsedated transnasal endoscopy (TNE) may be safer and less expensive than standard endoscopy (SE) for detecting Barretts esophagus (BE). Emerging technologies require robust evaluation before routine use.

    Objective

    To evaluate the sensitivity, specificity, and acceptability of TNE in diagnosing BE compared with those of SE.

    Design

    Prospective, randomized, crossover study.

    Setting

    Single, tertiary-care referral center.

    Patients

    This study enrolled consecutive patients with BE or those referred for diagnostic assessment.

    Intervention

    All patients underwent TNE followed by SE or the reverse. Spielberger State-Trait Anxiety Inventory short-form questionnaires, a visual analogue scale, and a single question addressing preference for endoscopy type were administered.

    Main Outcome Measurements

    Diagnostic accuracy and tolerability of TNE were compared with those of SE.

    Results

    Of 95 patients randomized, 82 completed the study. We correctly diagnosed 48 of 49 BE cases by TNE for endoscopic findings of columnar lined esophagus compared with the criterion standard, SE, giving a sensitivity and specificity of 0.98 and 1.00, respectively. The BE median length was 3 cm(interquartile range [IQR] 1-5 cm) with SE and3 cm(IQR 2-4 cm) with TNE, giving high correlations between the two modalities (R2 = 0.97; P < .001). The sensitivity and specificity for detecting intestinal metaplasia by TNE compared with those by SE was 0.91 and 1.00, respectively. The mean (± standard deviation) post-endoscopy Spielberger State-Trait Anxiety Inventory short-form score for TNE (30.0 ± 1.10 standard error of the mean [SEM]) was lower than that for SE (30.7 ± 1.29 SEM), (P = .054). The visual analogue scale scores were no different (P = .07). The majority of patients (59%) expressed a preference for TNE.

    Limitations

    This is a small study, with limited generalizability, a high prevalence of patients with BE, differential drop-out between the two procedures, and use of sedation.

    Conclusion

    TNE is an accurate and well-tolerated method for diagnosing BE compared with SE. TNE warrants further evaluation as a screening tool for BE.

    Abbreviations:  BE, Barretts esophagus, CI, confidence interval, IM, intestinal metaplasia, SE, standard endoscopy, STAI, Spielberger State-Trait Anxiety Inventory, TNE, transnasal endoscopy

     

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