Tu1044 IMPACT OF THE SAME DAY, UN-SEDATED, ULTRATHIN DISPOSABLE GASTROSCOPY IN THE MANAGEMENT OF CIRRHOTIC PATIENTS WHO ATTENDED OUTPATIENT CLINIC: A PROSPECTIVE LONGITUDINAL STUDY

Abstract

Ultrathin disposable gastroscope (TDG) can identify gastro-esophageal varices (GEVs) in cirrhotic patients [1]. The clinical impact of un-sedated TDG on the management of cirrhotic patients in outpatient setting is unknown. This study aimed to evaluate the feasibility, tolerability and clinical outcomes of performing the same day, un-sedated (TDG) for screening or surveillance of GEVs in cirrhotic patients who attend outpatient clinic. Cirrhotic patients who were scheduled to attend liver clinic for evaluation of portal hypertension were approached for the study. Subjects fasted 6 hours prior to the clinic appointment time for a potential upper gastroscopy. Study information was mailed to the patients 3 to 4 weeks prior, and the patient’s participation was confirmed a week prior the appointment. After hepatology consultation, patients who required an upper gastroscopy to assess for the presence of GEVs underwent an un-sedated TDG with oro-laryngeal local anaesthesia in the clinic. Videos were recorded in all patients so that the findings can be validated by an independent endoscopist. Spielberg’s State-Trait Anxiety Inventory (STAI-Y) score (0-100), visual analogue scale (VAS) pain score (0-10), VAS satisfactory score (0-100) and adverse effects were assessed. Clinical outcomes over 12 months after TDG were recorded in all patients. 24 consecutive cirrhotic patients (58.6 ± 1.2 years; 14 M:10F; alcohol =11, NAFLD =9, hepatitis C = 3 and hepatitis B =1) who met the inclusion criteria underwent un-sedated TDG for screening (n = 15) or surveillance (n = 9) of GEVs over 6 months. TDG identified GEVs in 19 (79%) patients, 4 of whom (15%) had high-risk GEVs. Inter-observer agreement for all GEVs was 88% (κ = 0.74), which increased to 94% (κ = 0.82) for high-risk GEVs. There were no adverse events from the TDG. 22(91%) patients were satisfied with the procedure, with low anxiety STAI-Y scores (29.9 ± 6.6) and low VAS pain score (2.2±1.2). All patients completed 12-month follow-up and TDG findings led to immediate change in management of 17 (70.8%) patients, in whom 15 (62.5%) received beta-blocker therapy and 2 (8.3%) underwent variceal band ligation. No patients re-presented earlier to hospital for variceal bleeding other than their annual review. This approach would prevent multiple hospital visits for conventional endoscopy, which is most beneficial for the 9 (38%) country patients. Same day un-sedated TDG to identify the presence of GEVs in cirrhotic patients is highly feasible and tolerable in outpatient setting. The high diagnostic yield (70%) with good inter-observer agreement allowed rapid decision making that can positively impact on the management of most patients and potentially reduces the number of hospital visits.