3559 T-egd: a new technique for accurately detecting and grading esophageal varices in cirrhotic patients.

Abstract

Background:Endoscopic screening of cirrhotic patients for large esophageal varices (EV) is advocated prior to initiation of prophylactic medical therapy for variceal bleeding. Conscious sedation for conventional endoscopy (CEGD), however, is problematic in cirrhotic patients due to the risk of prolonged encephalopathy. Previously, unsedated transnasal endoscopy (T-EGD) has been shown to be feasible for screening of cirrhotic patients for the presence of EV. Aims:Compare the diagnostic yield of T-EGD with C-EGD for detecting and grading of EV. Methods:Eleven cirrhotics (10 men, mean age 56)with no history of variceal bleeding, prior documentation of EV, severe thrombocytopenia or history of recurrent epistaxis were evaluated by T-EGD. Initially, unsedated T-EGD was done using a 5.3 mm endoscope. Immediately afterwards, a different endoscopist, blinded to the initial findings, performed sedated C-EGD. The presence and size of EV and gastric varices (GV) were recorded. Patient tolerance was evaluated based on a visual analogue scale. Results:Esophageal varices were detected by both modalities in six of eleven patients(table). No stigmata of variceal bleeding was noted by either modality. Average time for unsedated examination was 4.9 +/- 1.1 minutes. Patients found both procedures acceptable overall, with no significant difference in choking, discomfort, or sore throat. No untoward effects, including epistaxis, occurred. Conclusions:1) Esophageal varices are accurately detected and graded by T-EGD in cirrhotic patients. 2) T-EGD is a safe and less costly alternative for screening of cirrhotic patients for esophageal varices.