Comparative acceptability of transnasal esophagoscopy and esophageal capsule esophagoscopy: a randomized, controlled trial in veterans

Abstract

Background: EGD screening for Barrett's esophagus (BE) is costly, with insufficient evidence to support its effectiveness.

Objective: To compare acceptance and tolerability of 2 novel, office-based, endoscopic screening techniques done on nonsedated patients.

Design: Randomized block study design with allocation concealment.

Setting: Outpatient clinic setting at a Veterans Affairs medical center.

Patients: A total of 184 veterans with or without GERD symptoms.

Interventions: Transnasal esophagoscopy (TNE) or esophageal capsule esophagoscopy (ECE).

Main outcome measurements: Acceptance and tolerability of TNE and ECE and effectiveness of BE screening.

Results: Esophageal screening was accepted by 184 of 1210 (15.2%) veterans. The majority were men (96%) and African American (58%), with a mean (± standard deviation) age of 58.9 (± 8.1) years. Five TNE participants (5%) and 2 ECE participants (2%) refused the assigned procedure after randomization (P = .25). Eleven patients (12.6%) randomized to TNE crossed the minimal clinically important threshold for overall procedure tolerability, as opposed to no patients randomized to ECE (P = .001). Effectiveness of BE screening was not significantly different in both procedures (TNE vs ECE = 3.2% vs 5.4%; P = .47). Overall, BE was present in 8 of 75 white participants (10.6%) and in 0 of 107 African American participants (P < .001).

Limitations: The general veteran population may not reflect the screening population for BE.

Conclusion: Despite a small proportion of veterans expressing interest in esophageal screening, both TNE and ECE were feasible in the outpatient clinic setting and were accepted by >95% of participants who did express an interest. Screening was effective only in white participants. Moderate differences in tolerability between TNE and ECE notwithstanding, cost considerations along with availability of equipment and trained personnel should guide the modality to be used for BE screening.