Unsedated esophagoscopy for the diagnosis of esophageal varices in patients with cirrhosis

Background and Study Aims: Unsedated endoscopy with ultrathin endoscopes ha s been shown to be an alternative to conventional endoscopy. This technique would appear to be an ideal way to screen for varices, but there is scant data for unsedated endoscopy in patients with cirrhosis. The aims of this p ilot study were to evaluate whether unsedated endoscopy can be used to scre en for varices and to determine how well it is tolerated in patients with h epatic dysfunction. Patients and Methods: We prospectively evaluated unsedated esophagoscopy in 15 patients with cirrhosis who were candidates for beta-adrenergic-antagon ist therapy. Patients with cirrhosis without gastrointestinal bleeding or c ontraindications to beta-adrenergic-antagonist therapy gave consent to the procedure. The presence and size of varices and the procedure time were rec orded. After the procedure, patient tolerance, as gauged by questionnaire a nd willingness to repeat, was assessed. Results: All patients tolerated the procedure without significant discomfor t. The mean time of the procedure was 2 minutes. Esophageal varices were fo und in nine of 15 patients. Of these, one patient with Child-Pugh class C c irrhosis had large varices and was started on propranolol, Conclusions: Unsedated esophagoscopy in patients with cirrhosis appears to be well tolerated. Given both potential safety and cost benefits over conve ntional endoscopy, this could be a useful method for screening for varices, A randomized trial comparing this method with standard endoscopy is warran ted.