Unsedated transnasal endoscopy was shown to be a safe, well-tolerated and lower-cost alternative to esophagogastroduodenoscopy for evaluating pediatric eosinophilic esophagitis, according to recent study data.
“Our study provides strong support for larger studies to validate this approach,” Joel A. Friedlander, DO, MBe, from Children’s Hospital Colorado, said in a press release. “This technique has the potential to significantly improve the lives of children with EoE in a safer, cost-effective, and efficacious manner.”
To assess the performance of unsedated transnasal endoscopy with biopsies for monitoring pediatric EoE patients’ esophageal mucosa, Friedlander and colleagues analyzed biopsy specimens, procedure duration, adverse events, billing charges and patient preference in 21 children with EoE who underwent the procedure (mean age, 13.04 ± 2.7 years). All patients had undergone at least one previous EGD. The physicians used an Olympus BFXP160F 2.8-mm bronchoscope (1.2-mm channel) or an Olympus BPMP160F 4-mm flexible bronchoscope (2-mm channel) to perform transnasal endoscopy. Lidocaine was used for topical anesthesia and 3D movie goggles were used for patient distraction.
No serious adverse events occurred. Histopathological analysis showed 12 patients had zero eosinophils per high-power field (hpf), four patients had less than 15/hpf and five patients had greater than 15/hpf. Visual and histologic findings correlated in 85.7% of patients.
The total epithelial surface area of mucosal biopsy samples from transnasal endoscopy forceps was comparable to those obtained by previous EGD using standard endoscopic forceps. Transnasal endoscopy was preferred over EGD by 85.7% of parents and 52.4% of patients, while all of the parents and 76.2% of patients said they would undergo the procedure again. The modified Group Health Association of America 9 survey completed a minimum of 2 weeks after the procedure showed an average score of 43.19 ± 2.6 out of 45. Costs associated with the procedure were 60.1% ± 10.7% lower compared with previous sedated EGDs with biopsies, which included charges for anesthesia, pathology, facility fees and physician fees. Mean combined charges for 11 sedated EGDs was $9,390.79 ± $2,224.42 compared with $3,547.96 ± $254.42 for transnasal endoscopy, representing a 62.2% reduction in total charges billed.
“In conclusion, the implementation of [transnasal endoscopy] in pediatric gastroenterology for the evaluation ofpediatric EoE is safe, is preferred by patients and parents alike, and has the potential to dramatically reduce costs,” the researchers wrote. – by Adam Leitenberger
Disclosure: Friedlander reports he is a consultant for QOL Medical. Please see the study for a full list of all other authors’ relevant financial disclosures.
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