Feasibility and Tolerance of the New 5.5 mm 4-Way Angulation Videoscope for Transnasal EGD for the Unsedated GI Cancer Screening in the Elderly People-Comparison with 5.2 mm 2-Way Angulation Videoscope

Abstract

The quality difference of transnasal EGD with 4-way and 2-way angulation scopes has not been elucidated. The smallest 5.5 mm 4-way angulation videoscope for transnasal EGD has been recently developed by Olympus (Tokyo, Japan), expecting both better transnasal insertion capability and physicians' maneuver. Aim: To evaluate the feasibility and tolerance of the new 4-way angulation videoscope in the unsedated transnasal EGD. Methods: For the unsedated GI cancer screening in the elderly people, transnasal EGD with XGIF-XP240N2 (Field Sequential System, Field of View 120°, Distal End 5.0 mm, Insertion Tube 5.5 mm, Angulation Up210° Down90° Right100° Left100°, Instrument Channel 2 mm) (4 way) (n = 90 M65 F25 average 62.3 y.o. unsedated oral EGD experience 87%) and GIF-N260 (Field Sequential System, Field of View 120°, Distal End 4.9 mm, Insertion Tube 5.2 mm, Angulation Up210° Down120°, Instrument Channel 2 mm) (2 way) (n = 127 M83 F44 average 61.3 y.o. unsedated oral EGD experience 90%) were performed. Written informed consents were taken for all subjects regarding transnasal EGD procedure. Both scopes have the same optical system using the same CCD. Feasibility was compared with scores (1 poor - 5 excellent, 0 not available) modified from Dumortier et al (Gastrointest Endosc 1999;49:285-91), regarding duodenal second portion insertion(DI), target biopsy(TB), quality of whole upper GI observation(WO). The transnasal insertion rate(IR), epistaxis rate(ER) and examination time (ET) with(wB) or without biopsy (oB) were also compared. Tolerance was evaluated as the nasal pain rate (NP), the subjects' preference rate (PR) of transnasal EGD for the next examination. Feasibility scores and examination time were investigated in 78 cases for 4 way and 100 cases for 2 way after subjects with post operated stomach or cascade stomach were excluded. Results: Data were expressed as 4 way versus (vs) 2 way with the values of mean ± SD. Mann-Whitney's U test and chi-square test were used for statistics. Feasibility scores were DI3.1 ± 1.3 vs 3.2 ± 1.3 (ns), TB 3.2 ± 0.9 vs 3.3 ± 1.1 (ns), WO3.0 ± 0.9 vs 3.0 ± 1.0 (ns). DI was not available in 4 case for 4 way (5%) and 2 cases for 2 way (2%), while all TB was available with both scopes. Other data were IR 95.6% vs 89.8% (ns), ER 5.8% vs 7.0% (ns), ETwB 469 ± 74.8 sec (11 cases) vs 606 ± 136 sec (17 cases) (p = 0.002), EToB 390 ± 110 sec (67 cases) vs 371 ± 95.1 sec (83 cases) (ns), NP18% vs 26% (ns) and PR 67% vs 66% (ns) (ns: not significant). Conclusion: For transnasal EGD in the elderly people, the new 4-way angulation videoscope shortened examination time with biopsy than 2-way scope, preserving transnasal insertion rate and tolerance.