Interventional gastroenterology

Ultra-thin gastroscopy a valid alternative for surveillance of varices

The use of ultra-thin endoscopes in gastroscopy screening and surveillance of oesophageal varices associated with cirrhosis may mitigate the risks from repeated conventional gastroscopy, Queensland gastroenterologists say.

Potential risks from conventional gastroscopy include those related to conscious sedation used to make the procedure tolerable for patients, according to a review led by Dr Tehara Wickremeratne, of ther Deaprtament of Gastroenterology and Hepatology, Sunshine Coast University Hospital.

Their systematic review and meta-analysis of the literature on ultra-thin gastroscopy (shaft diameter ≤6 mm) versus conventional gastroscopy (shaft diameter 9mm) found a high level of diagnostic accuracy.

The review identified 10 studies with a total of 752 patients. A variety of ultra-thin endoscopes were used with shaft diameters ranging from 3.1 to 5.3mm. Most studies (8 of 10) did not involve conscious sedation for ultra-thin gastroscopy.

The meta-analysis found the overall prevalence of oesophageal varices was 42%. The sensitivity of ultra-thin gastroscopy to diagnose varices ranged from 80% to 100% and specificity 78% to 100%.

“Using the prevalence of oesophageal varices in the 10 studies (42%) as the pre‐test probability, we obtained a post‐test probability of 95% if the test was positive, and a post‐test probability of 1.4% if the test was negative,” the review authors said.

Pooled sensitivity was a high 98% for the six studies assessing ultra-thin gastroscopy for medium to large varices.

Sensitivity ranged from 96% to 100% and specificity from 91% to 100% in three studies of ultra-thin gastroscopy for all high-risk varices.

And three studies assessing the accuracy of ultra-thin gastroscopy for gastric varices had a sensitivity of 100% and specificity of 97% to 100%.

“No serious adverse effects occurred in any of the six studies that reported this outcome. Of the seven studies that reported on tolerability, six studies reported equivalent or improved tolerability with UTG.”

The study concluded that ultra-thin gastroscopy was feasible, safe and well tolerated.

“Given the thin calibre of the ultra-thin endoscope, it is well tolerated even when performed unsedated.”

It was also an attractive alternative to conventional gastroscopy as the endoscopic technique was similar, and the grading system for varices was identical, therefore requiring no further endoscopic training.

The researchers noted however that there hasn’t been a widespread uptake of ultra-thin gastroscopy in clinical practice in Australia.

“This may be due to several factors; including historical differences in technical features such as image quality and lack of tip control not being equal to standard high resolution endoscopy, differences in financial reimbursement for in‐clinic ultrathin procedures compared with standard procedural‐suite endoscopy, and the lack of option for therapy; which is especially pertinent given that some clinicians may prefer variceal banding as opposed to nonselective beta‐blockers for primary prophylaxis,” they wrote.

The authors had no declarations of personal interests.

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