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Meta-Analysis
. 2023 Jan 28;36(2):doac045.
doi: 10.1093/dote/doac045.

Unsedated transnasal endoscopy for the detection of Barrett's esophagus: systematic review and meta-analysis

Lotte J Huibertse  1 , Yonne Peters  1 , Dieuwertje Westendorp  1 , Peter D Siersema  1
Affiliations
Meta-Analysis

Unsedated transnasal endoscopy for the detection of Barrett's esophagus: systematic review and meta-analysis

Lotte J Huibertse et al. Dis Esophagus. .

Abstract

Conventional esophagogastroduodenoscopy (cEGD) is currently the gold standard endoscopic procedure for diagnosis and surveillance of Barrett's esophagus (BE). This procedure is however less suitable for widespread screening because of its invasiveness and costs. An alternative endoscopic procedure is unsedated transnasal endoscopy (uTNE). We performed a systematic review and meta-analysis to evaluate the diagnostic accuracy, patient tolerability, technical success rate, and safety of uTNE compared with cEGD for detecting BE and related neoplasia. PubMed, EMBASE, and Cochrane Library were searched for studies that reported the diagnostic accuracy of uTNE compared with cEGD for detecting BE and related neoplasia. Eight prospective studies were included, in which 623 patients underwent both uTNE and cEGD. Pooled sensitivity and specificity of uTNE for detecting columnar epithelium were 98% (95% CI 83-100%) and 99% (95% CI 82-100%), respectively. Pooled sensitivity and specificity of uTNE for detecting intestinal metaplasia in biopsies were 89% (95% CI 78-95%) and 93% (95% CI 71-98%), respectively. In three of the six studies that reported patient tolerability, a higher patient tolerability of uTNE compared with cEGD was reported. The technical success rate of uTNE ranged from 89% to 100% and no (serious) adverse events were reported. This systematic review and meta-analysis provides evidence that uTNE is an accurate, safe, and well-tolerated procedure for the detection of columnar epithelium and can be considered as screening modality for BE.

Keywords: biopsy; screening; transnasal endoscopy; Barrett’s esophagus.

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Figures

Fig. 1
Fig. 1
Flowchart of the study selection process.
Fig. 2
Fig. 2
(a) Forest plot with diagnostic accuracy of detecting columnar epithelium (sensitivity and specificity) of individual studies. (b) Graph including (1) ‘Study estimate’ = individual study estimates; (2) ‘Summary point’ = summary values for sensitivity and specificity; (3) ‘HSROC-curve’ = a summary curve from the HSROC model; and (4) ‘95% confidence region’ = 95% confidence region for the summary point.
Fig. 3
Fig. 3
(a) Forest plot with diagnostic accuracy of detecting intestinal metaplasia in biopsies (sensitivity and specificity) of individual studies. (b) Graph including (1) ‘Study estimate’ = individual study estimates; (2) ‘Summary point’ = summary values for sensitivity and specificity; (3) ‘HSROC-curve’ = a summary curve from the HSROC model; and (4) ‘95% confidence region’ = 95% confidence region for the summary point.
See this image and copyright information in PMC

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