Acurácia, concordância interobservador e segurança da endoscopia ultrafina transnasal sem sedação comparada à endoscopia convencional com sedação para a pesquisa de varizes de esôfago em pacientes cirróticos

• Autor(a) principal: Castro Filho, élio Cunha
• Data de Publicação: 2017
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/8632
• topic: Liver cirrhosis; Esophageal varices; Transnasal endoscopy; Cirrose hepática; Varizes de esôfago; Endoscopia digestiva transnasal; CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::GASTROENTEROLOGIA

Transnasal ultrathin gastrointestinal endoscopy is a promising method for assessing esophageal varices in cirrhotic patients, since it requires no sedation and is considered safe and well tolerated, according to Eastern experience. However, there are only small and limited studies evaluating the performance of this method in the evaluation of esophageal varices, as well as its safety, in Western countries. This study aims: (i) to determine the accuracy of transnasal ultrathin endoscopy in the evaluation of esophageal varices in cirrhotic patients; (ii) to evaluate the interobserver agreement of the method; (iii) to assess the safety of transnasal endoscopy. Cirrhotic patients were submitted consecutively to the two endoscopies on the same day. First through the transnasal route without sedation, then through the peroral route under moderate sedation. Both exams were recorded for further evaluation by two blinded endoscopists. Vital signs and adverse events were registered before, during and after both procedures. As results, 133 patients were included, 52% women, with mean age 60 ± 5 years. 70% had hepatitis C and 34% had decompensated cirrhosis. Transnasal endoscopy revealed Se= 94% [CI 88-99] / Sp= 89% [81-97] for the general detection of esophageal varices and Se= 90% [80-99] / Sp= 90% [85-96] ] for identification of high-risk varices. Considering transnasal endoscopy, the kappa value for detection of esophageal varices was 0.83, and for high-risk varices was 0.65. The interobserver agreement was higher in the screening subgroup, with k= 0.89 for the presence of varices and k = 0.72 for high-risk varices compared to the surveillance subgroup for the presence of varices and for high-risk varices (k=0,60 e k=0,49, respectively). There were no serious adverse events in both endoscopies. During transnasal endoscopy there was only 1 case of mild and self-limited epistaxis (0.74%). The proportion of hypoxemia (22% vs 1%, p <0.0001) and hypotension (14% vs 3%, p <0.0001) was higher in conventional versus transnasal endoscopy. Mean arterial pressure and heart rate were more stable in transnasal than in conventional endoscopy. In conclusion, transnasal ultrathin endoscopy without sedation is a reliable, safe and accurate method for detecting esophageal varices in patients with cirrhosis, with good interobserver agreement and might be a good option for the evaluation of esophageal varices in cirrhotic patients more susceptible to sedative drugs and those with decompensated liver disease.