Evidence map›Paper›PMID 34925746›Full record

ArticleFrontline gastroenterology2021

One-stop shop for variceal surveillance: integration of unsedated ultrathin endoscopy into the routine clinic visit.

Ali Eqbal, Tehara Wickremeratne, Stephanie Turner, Sarah Elizabeth Higgins, Andrew Sloss, Jonathan Mitchell, James O'Beirne

Open access · greenAbstract read
In one paragraph

Article in Frontline gastroenterology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
0.5field-weighted citation impact, top 39% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it, 7 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 1 country.

Ali EqbalGastroenterology & Hepatology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.ORCID 0000-0001-5448-5873
Tehara WickremeratneGastroenterology & Hepatology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.
Stephanie TurnerGastroenterology & Hepatology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.
Sarah Elizabeth HigginsGastroenterology & Hepatology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.
Andrew SlossGastroenterology & Hepatology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.
Jonathan MitchellGastroenterology & Hepatology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.
James O'BeirneGastroenterology & Hepatology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.ORCID 0000-0003-3400-2816
Sunshine Coast University Hospital · AUUniversity of the Sunshine Coast · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe endoscopic appearance of oesophageal varices determines the need for prophylaxis. However, as the point prevalence of varices is low (25%), the majority of surveillance endoscopies are unnecessary and costly. Narrow diameter, ultrathin (UT) endoscopes are more tolerable than conventional upper gastrointestinal (UGI) endoscopes and can be used without sedation. We hypothesised that unsedated UT endoscopy for variceal surveillance could be implemented during the routine outpatient clinic visit allowing accurate diagnosis of varices and the timely provision of prophylaxis.

methodsPatients with cirrhosis awaiting surveillance endoscopy were identified. UT endoscopy was scheduled during routine clinic review at the same time as ultrasound surveillance for hepatocellular carcinoma. UGI endoscopy was performed unsedated using the E.G Scan II disposable endoscope. Varices were graded using the modified Paquet classification. Video recordings of procedures were reviewed by blinded assessors and agreement was assessed using the kappa statistic.

results40 patients (80% male) underwent unsedated UT endoscopy. All procedures were successful and tolerated well in 98% of cases. Median procedure time was 2 min (IQR 1-3). Varices were found in 37.5% (17.5% grade 1 and 20% grade 2). Patients with grade 2 varices were prescribed non-selective beta blockers at the clinic appointment. Kappa statistic for the finding of any varices was 0.636 (p=0.001) and 0.8-1.0 for diagnosis of grade 2 varices (p<0.0001).

conclusionsOutpatient unsedated ultrathin endoscopy in patients with cirrhosis is accurate, safe and feasible. This integrative care model is convenient, particularly for regional communities, and is likely to result in significant cost savings associated with variceal surveillance.

Indexed as

cirrhosisclinical decision makingendoscopyhealth economicsoesophageal varices

Identifiers

PMID34925746
PMCPMC8640389
OpenAlexW3119354092

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.