Unsedated transnasal endoscopy may be used for detecting esophageal varices. However, few studies evaluated feasibility and accuracy of this technique. We aimed to evaluate accuracy, interobserver agreement and safety of the transnasal ultrathin compared to conventional endoscopy in patients with cirrhosis.
This cross-sectional study included consecutive patients referred for screening or surveillance of esophageal varices. Patients underwent unsedated transnasal and sedated conventional endoscopies at the same day, which were recorded in a digital video file and randomly analyzed by two double-blinded endoscopists. High-risk varices were defined by presence of large caliber or red wale marks. Accuracy, interobserver agreement and safety of transnasal were compared to conventional endoscopy.
133 cirrhotic patients [48% male, aged of 60 ±5, 34% Child-Pugh B/C and 71% of cases for variceal screening] were included .The prevalence of esophageal varices and high-risk esophageal varices were 59% (n=79) and 29% (n=39), respectively. For presence of esophageal varices, transnasal GIE yielded sensitivity of 94% [95%Confidence Interval, CI 88-99], specificity of 89% [81-97], as well as positive and negative predictive value of 93% and 91%, respectively. A satisfactory interobserver agreement was observed for presence of esophageal varices (kappa=0.89) and high-risk varices (kappa=0.65). No serious adverse events were recorded, transnasal GIE was safe and significantly associated with lower rates of hypoxemia (p<0.0001) and hypotension (p<0.0001) compared to conventional endoscopy.
Unsedated transnasal endoscopy was safe and had an excellent accuracy and high interobserver agreement for detecting esophageal varices and for identifying high-risk varices in cirrhotic patients.
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