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OBJECTIVE To summarize the existing literature for several promising minimally invasive tests to measure disease activity in eosinophilic esophagitis (EoE). DATA SOURCES Literature searches were performed using PubMed. Keyword combinations included eosinophilic esophagitis and minimally invasive techniques, including the esophageal string test, Cytosponge, transnasal endoscopy, technetium-labeled heparin, and noninvasive biomarkers. STUDY SELECTIONS Retrospective and prospective observational studies, peer-reviewed reviews, and systematic reviews were selected. Data were reviewed and summarized. RESULTS Various techniques have been developed in recent years to measure disease activity in EoE without the need for conventional endoscopy. Our review summarizes the data on these techniques, the benefits and limitations, and future directions for implementation in both research and clinical care. CONCLUSION Tremendous progress has been made toward developing minimally invasive techniques to measure disease activity in EoE. Each of the techniques mentioned in this review has advantages and disadvantages, and some are closer to widespread use than others.

Esophageal squamous cell carcinoma (ESCC) is the most common type of esophageal cancer worldwide, with a high mortality due to advanced stage at diagnosis. Although most common in an area known as the Asian Esophageal Cancer Belt, which extends from the Caspian Sea to northern China, and in parts of Africa, high-risk populations also exist elsewhere in the world. Screening for ESCC has been practiced in a few geographic areas and high-risk populations, with varying levels of success. Esophageal squamous dysplasia is recognized as the precursor lesion for ESCC. Endoscopic screening for ESCC/esophageal squamous dysplasia is expensive and not sufficiently available in many high-risk regions. Recent advances in non-endoscopic screening enhanced by biomarker-based disease detection have raised the prospect of improved accuracy and availability of screening for esophageal squamous dysplasia and early stage ESCC. Development of a cost-effective, accurate, and well-tolerated screening test, if applied in endemic areas and high-risk populations, has the potential to reduce mortality from this deadly disease worldwide. In this review, we summarize recent developments in endoscopic and non-endoscopic screening modalities.

Barrett’s esophagus (BE) predisposes patients to esophageal adenocarcinoma (EAC). 3 to 6% of individuals with gastro-esophageal reflux disease (GERD) are estimated to have BE but only 20 to 25% of BE patients are currently diagnosed. With effective endoscopic treatment methods for dysplasia and early cancer having shifted the balance in favour of screening an acceptable and affordable screening strategy is now required. The current gold standard for diagnosis of BE is per-oral upper GI endoscopy (EGD). As this is not suitable for large-scale screening, a number of alternative methods are currently being investigated: transnasal and video capsule endoscopy, endomicroscopy, cell collection devices like the cytosponge and biomarkers. Some of these are promising; however, the majority of studies were carried out in BE enriched populations mostly in secondary care, so it is not possible to extrapolate to screening populations. Instead, well powered studies carried out in the relevant populations are needed.

Prior to adaptation of endoscopic approaches for sinonasal pathology, patients regularly endured significant morbidity from open approaches to the sinonasal cavity that were often fraught with failure. With improvements in transnasal endoscopy, functional endoscopic sinus surgery subsequently emerged from the work of Messerklinger and other pioneers in the field. The popularity of endoscopic sinus surgery quickly escalated and expanded to pathology other than inflammation. Here, we discuss the evolution of endoscopic sinus surgery as it relates to improvements in understanding disease pathogenesis, improvements in instrumentation and expansion of indications. Keywords: Chronic sinusitis, Endoscopic sinus surgery, Skull base surgery

Background/Purpose Differences in patient tolerance, acceptance, and satisfaction of esophagogastroduodenoscopy (EGD) between transnasal (TN) and peroral (PO) routes using a 5-mm video endoscope. Methods A total of 220 enrolled patients were assigned randomly to two groups undergoing EGD—110 patients each for TN and PO. The successful rate, procedure time, and adverse events were recorded. After the procedure, patients answered a validated questionnaire of tolerance, acceptance, and satisfaction. Results There were 6 failures (5.7%) of nasal intubation and two nasal bleeding (2%) among 105 TN-EGD procedures. All PO patients ( n = 102) completed EGD successfully without adverse event. Compared to PO, the procedure of TN achieved lower successful rate (94% vs. 100%, p = 0.01), was complicated with epistaxis (2% vs. 0%) and took longer (mean ± SD 19.9 ± 6.1 min vs. 16.8 ± 6.4 min, p = 0.0001). The patients undergoing TN-EGD indicated less discomfort during passing pharynx (scores of 2.1 ± 2.0 vs. 3.1 ± 2.6, p = 0.011) but more pain during inserting scope (scores of 2.2 ± 1.6 vs. 1.5 ± 1.8, p = 0.0001). Eventually, there were no significant differences between TN and PO regarding the overall procedure discomfort (scores of 10.7 ± 6.6 vs. 11.1 ± 7.8 scores, p = 0.9), satisfaction (scores of 41.2 ± 4.2 vs. 41.3 ± 4.6, p = 0.91), and acceptability (87.8% vs. 94.2%, p = 0.91). Conclusion PO intubation seems an excellent alternative method when using a 5-mm ultrathin endoscopy because it achieves comparable patient tolerance, acceptance, and satisfaction as TN intubation, takes less time and causes lower intubation failure and epistaxis.

Sinonasal foreign bodies are rare clinical entities. Their presence in the sinuses can originate complications, so their removal is always indicated. We present 3 cases of sinonasal foreign body, indicating their symptoms, imaging findings and surgical removal. Each patient was assessed with computerized tomography of the sinuses, rigid endoscopy, and then surgical removal. We confirmed the presence of the foreign bodies in all 3 cases and then performed a successful surgical removal by transnasal endoscopy. Sinonasal foreign bodies are infrequent entities that require surgical removal to prevent complications, with transnasal endoscopic surgery being the most commonly used surgical approach.

Background Transnasal endoscopy with a small-caliber endoscope has been shown to be helpful for the placement of nasoenteral feeding tubes in patients who are critically ill. Success rates were limited by the short working length of the small-caliber endoscopes. Objective To compare the success rate of a 133-cm-long, small-caliber, prototype videoendoscope with a standard 92-cm-long, small-caliber, fiberoptic endoscope for the transnasal placement of feeding tubes. Design Randomized controlled study. Setting University Hospital of Zurich, Switzerland. Patients Patients who were critically ill were randomly assigned to transnasal feeding tube placement with the standard 92-cm-long, small-caliber, fiberoptic endoscope, or with a new 133-cm-long, small-caliber, prototype videoendoscope. Patient characteristics, procedure time, technical difficulties, patient tolerance, and radiologic tube position were assessed. Main Outcome Measurements Success rates of endoscopic placement of enteral feeding tubes. Results A total of 157 patients were analyzed in 2 groups. The 2 groups were similar with regard to patient characteristics, body length, technical difficulty, and patient tolerance. The 133-cm-long instrument was superior with respect to successful placement of the nasoenteral feeding tube (93.6% vs 74.4%, P = .0008). Patient tolerance, procedure times, and overall technical difficulty were the same in both treatment groups, whereas passage through the duodenum was more difficult with the 133-cm-long instrument ( P Limitations In rare cases, the randomization list could not be followed correctly. Conclusions This study demonstrated that placement of a nasoenteral feeding tube with a 133-cm-long, small-caliber videoendoscope is feasible, safe, and distinctly more successful than with a 92-cm-long, small-caliber standard instrument.

Background: Unsedated transnasal upper endoscopy has a diagnostic yield comparable with that of sedated conventional upper endoscopy. The ability of transnasal upper endoscopy to detect Barrett's metaplasia or dysplastic change has not been systematically evaluated. The aim of this study was to assess the feasibility of transnasal upper endoscopy for surveillance of patients with Barrett's esophagus and to evaluate its histopathologic yield for Barrett's metaplasia and dysplasia. Methods: Thirty-two patients with Barrett's esophagus were evaluated with conventional upper endoscopy and transnasal upper endoscopy. An effort was made to recruit patients known to have dysplasia. Quadrantic biopsy specimens were taken with standard (conventional upper endoscopy) and pediatric (transnasal upper endoscopy) biopsy forceps at procedures performed at least 1 week apart. Two blinded pathologists evaluated the specimens. Results: Transnasal upper endoscopy detected Barrett's metaplasia histopathologically in 31 of 32 patients. Level of agreement for presence of dysplasia in biopsy specimens obtained between conventional upper endoscopy and transnasal upper endoscopy was excellent (k = 0.79). Interobserver agreement for dysplasia in specimens obtained by conventional upper endoscopy (k = 0.61) and by transnasal upper endoscopy (k = 0.61) were similar. Intraobserver agreement between conventional upper endoscopy and transnasal upper endoscopy biopsy specimens for dysplasia by pathologist 1 (k = 0.73) and pathologist 2 (k = 0.75) were also similar. No significant adverse effects were noted. Conclusions: Transnasal upper endoscopy is feasible and accurate for identification and histopathologic confirmation of Barrett's metaplasia with a histopathologic yield for dysplasia comparable with conventional upper endoscopy. (Gastrointest Endosc 2002;56:472-8.)

Transnasal, Ultrathin Endoscopy for the Placement of Nasoenteral Feeding Tubes in Critically Ill Patients: Does the Working Length of the Endoscope Matter? First Results Stephan Wildi, Christoph Gubler, Stephan Vavricka, Dieter Menne, Michael Fried, Peter Bauerfeind Background: Early enteral feeding may improve outcomes in critically ill patients. Transnasal endoscopy with an ultrathin endoscope has been shown to be helpful for the placement of nasoenteral feeding tubes in these patients. Success rates were limited by the short working length of the ultrathin endoscopes. Aim: To compare the success rate of a 133 cm-long, ultrathin video-endoscope with a standard 92.5 cm-long, ultrathin, fiberoptic endoscope for the transnasal placement of nasoenteral feeding tubes. Methods: Critically ill patients were randomly assigned to transnasal feeding tube placement with the standard 92.5 cm-long, ultrathin, fiberoptic endoscope (Olympus GIF-N30) or a new 133 cmlong, ultrathin, prototype video-endoscope (Olympus XGIF-N140Y). Patients characteristics, procedure time, technical difficulties, patient tolerance, and radiologic tube position were assessed. Results: To date, 89 patients (29 women; mean age 51.8, range 20-81) were analyzed. The two groups were similar with regard to patients characteristics, body length, technical difficulty and patient tolerance. So far, the 133 cm-long instrument tended to be superior with respect to successful placement of the nasoenteral feeding tube (90% vs. 76%). Procedure time tended to be longer with the 133 cm-long instrument (557sec vs. 462sec). Conclusions: This ongoing study demonstrates that placement of a nasoenteral feeding tube with a 133 cm-long, ultrathin video-endoscope is safe and tends to be more successful than with 92.5 cm-long, ultrathin, standard instrument. Abstracts