Unsedated Screening Esophagoscopy For Barrett'S Esophagus In A Primary Care Va Setting

Sedated EGD is a costly method for Barrett's esophagus (BE) screening that has had limited impact on esophageal cancer. Unsedated small-caliber esophagoscopy has been proposed as a screening alternative but has not been studied. Aims: To determine the effectiveness of unsedated esophagoscopy screening in an outpatient setting of a VA hospital. Methods: All medicine outpatients at the VA are randomized into two groups based on social security numbers. Patients in Group A over the age of 45 with chronic GERD symptoms (<5 years or >3 times a week) were identified. Those who had no prior EGD or no EGD in the previous five years were offered screening with a 4 mm diameter video esophagoscope (Olympus XEF-130Y1) using only topical pharyngeal anesthesia. Group B was the control group. Results: Of the fifty eligible patients identified in Group A, twenty two (44%) refused esophagoscopy screening. Six (27.3%) of the refusals were because of lack of sedation. Of patients undergoing the procedure, five of 28 had suspected BE (one long-segment BE and four short-segment BE). Sedated EGD with biopsy confirmed the long-segment BE, did not confirm two of the cases of suspected short-segment BE, and is pending on the other two suspected cases of BE. During the six months of the study, no new cases of BE were identified in patients in Group B. Median patient rating of discomfort was five on a ten-point scale with a range of one to nine. Twenty five of the 28 patients would agree to repeat esophagoscopy in five years, and all of the screened patients would recommend unsedated esophagoscopy to a friend. Conclusions: Unsedated esophagoscopy appears to be a useful method of screening for BE in a VA population with GERD. Patient tolerance and acceptance of screening esophagoscopy is reasonably good. Esophagoscopy screening was successful in identifying BE that would otherwise not have been diagnosed.