Endoscopic meatus scoring scale <i>versus</i> sniff test to predict insertability before transnasal endoscopy: A prospective, randomized study

Hu, Chi-Tan; Lei, Wei‐Yi; Lin, Jen-Shung; Hung, Jui‐Sheng

doi:10.1111/jgh.13810

Cited by 3 publications

(5 citation statements)

References 33 publications

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“…Official guidelines are not in existence, however, uTNE should be avoided in patients with altered nasal anatomy, severe coagulopathy, and previous nasal trauma or nasal surgery in order to limit epistaxis risk. Other rare complications include mucous discharge, dizziness, headache, earache, eye discharge and sinusitis; however these have been small in number [8,11] and are therefore of limited significance. (Table 1) In 2-6% of cases there is failure of nasal intubation due to narrow nasal passages [12]; in the past we routinely assessed nasal patency pretreatment with a 14/16 French nasal catheter prior to attempting intubation, this, however, is no longer considered necessary, as intubation can be achieved effectively under direct visualization.…”

Section: Performing Transnasal Endoscopy-practicalities and Limitationsmentioning

confidence: 99%

Unsedated Transnasal Endoscopy: A Safe, Well-Tolerated and Accurate Alternative to Standard Diagnostic Peroral Endoscopy

et al. 2022

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Diagnostic unsedated transnasal endoscopy (uTNE) has been proven to be a safe and well-tolerated procedure. Although its utilization in the United Kingdom (UK) is increasing, it is currently available in only a few centers. Through consideration of recent studies, we aimed to perform an updated review of the technological advances in uTNE, consider their impact on diagnostic accuracy, and to determine the role of uTNE in the COVID-19 era. Current literature has shown that the diagnostic accuracy of uTNE for identification of esophageal pathology is equivalent to conventional esophagogastroduodenoscopy (cEGD). Concerns regarding suction and biopsy size have been addressed by the introduction of TNE scopes with working channels of 2.4 mm. Advances in imaging have improved detection of early gastric cancers. The procedure is associated with less cardiac stress and reduced aerosol production; when combined with no need for sedation and improved rates of patient turnover, uTNE is an efficient and safe alternative to cEGD in the COVID-19 era. We conclude that advances in technology have improved the diagnostic accuracy of uTNE to the point where it could be considered the first line diagnostic endoscopic investigation in the majority of patients. It could also play a central role in the recovery of diagnostic endoscopic services during the COVID-19 pandemic.

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Section: Performing Transnasal Endoscopy-practicalities and Limitationsmentioning

confidence: 99%

Unsedated Transnasal Endoscopy: A Safe, Well-Tolerated and Accurate Alternative to Standard Diagnostic Peroral Endoscopy

et al. 2022

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“…In transnasal endoscopy, nasal pain is the most frequent symptom during insertion 6 14 . Our results revealed that nasal breathing resulted in less nasal pain and discomfort than oral breathing.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies showed that the success of transnasal intubation depended on the nasal pretreatment, nasal meatus selection, scope diameter, and endoscopist's skill [2,[14][15].…”

Section: Introductionmentioning

confidence: 99%

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Nasal breathing is superior to oral breathing when performing and undergoing transnasal endoscopy: a randomized trial

et al. 2022

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Background and study aims: Transnasal endoscopy presents a technical difficulty when inserting the flexible endoscope, and it is unclear whether a particular breathing method is useful for transnasal endoscopy. Therefore, we conducted a prospective randomized controlled trial to compare endoscopic operability and patient tolerance between patients in the nasal breathing and oral breathing groups. Patients and methods: A total of 198 eligible patients were randomly assigned to undergo the transnasal endoscopy with nasal breathing and with oral breathing. Endoscopists and patients answered questionnaires on the endoscopic operability and patient tolerance using a 100-mm visual analog scale ranging from 0 (non-existent) to 100 (most difficult/ unbearable). The visibility of the upper-middle pharynx was recorded. Results: Patient characteristics didn’t differ significantly in both groups. Nasal breathing showed a higher rate of good visibility of the upper-middle pharynx than oral breathing (91.9% vs. 27.6%; p<0.05). Nasal breathing showed lower scores than oral breathing in overall technical difficulty (21.0±11.4 vs. 35.4±15.0; p<0.05). Regarding patient tolerance, nasal breathing showed lower scores than oral breathing in overall discomfort (22.1±18.8 vs. 30.5±20.9; p<0.05) and other symptoms, including nasal and throat pain, choking, suffocating, gagging, belching, and bloating (p<0.05). Pharyngeal bleeding rate was lower in the nasal breathing group than that in the oral breathing group (0% vs. 9.2%; p<0.05). Conclusions: Nasal breathing is superior to oral breathing in performing and undergoing transnasal endoscopy. Nasal breathing led to good visibility of the upper-middle pharynx, improved endoscopic operability and patient tolerance, and showed safety by decreasing pharyngeal bleeding.

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“…In the TNA condition, a mixture of 1 mL of 2% viscous lidocaine hydrochloride and 1 mL of lubricant was injected up one naris via a syringe. The selected naris of entry was based on the sniff test 40,41 and participant preference. In the placebo condition, 2 mL of lubricant was applied to the same naris.…”

Section: Equipmentmentioning

confidence: 99%

Effect of Topical Nasal Anesthetic on Comfort and Swallowing in High‐Resolution Impedance Manometry

et al. 2022

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Objectives/Hypothesis: Use of topical nasal anesthetic (TNA) is common in high-resolution impedance manometry (HRIM). This study investigated the effect of TNA on swallowing and procedure tolerability during HRIM with a 4.2-mm catheter, a more commonly used catheter size with impedance capabilities.Study Design: Randomised experimental study with blinding of participants. Methods: Twenty healthy participants (mean age = 33 years, 16 female) were randomized to undergo HRIM using the ManoScan™ ESO Z 4.2-mm catheter twice, 1 week apart, under two conditions: with TNA (viscous lidocaine) and with placebo. Analyses included esophageal data of three saliva, three saline (5 mL), and three bread swallows (2 cm Â 2 cm) performed while reclined 45 , and pharyngeal data under the same conditions while seated upright. Pharyngeal and upper esophageal sphincter (UES) HRIM parameters were analyzed using the Swallow Gateway analysis platform. Visual analogue scale (VAS) scores rating procedural comfort were analyzed.Results: There were no significant physiological differences in pharyngeal and UES parameters between conditions. There were also no significant differences in VAS scores under placebo (mean = 54.8, standard deviation (SD) = 19.3) and TNA (mean = 60.0, SD = 21.9) (t[19] = À0.9, P = .4) conditions; however, there was a significant difference in the first versus second session (t[19]) = 5.1, P < .05).Conclusions: TNA did not improve comfort, but it also did not significantly affect swallowing behavior. There was, however, a practice effect regardless of TNA use with improved tolerance of the 4.2-mm catheter and likely more natural swallowing behavior during the second session of HRIM.

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Endoscopic meatus scoring scale versus sniff test to predict insertability before transnasal endoscopy: A prospective, randomized study

Abstract: Selection of an optimal meatus insertion tract by an anterior meatuscopy causes lesser nasal pain, epistaxis, and post-procedural side effects in nasal anesthesia and UT-EGD than the conventional sniff test.

Cited by 3 publications

References 33 publications

Unsedated Transnasal Endoscopy: A Safe, Well-Tolerated and Accurate Alternative to Standard Diagnostic Peroral Endoscopy

Unsedated Transnasal Endoscopy: A Safe, Well-Tolerated and Accurate Alternative to Standard Diagnostic Peroral Endoscopy

Nasal breathing is superior to oral breathing when performing and undergoing transnasal endoscopy: a randomized trial

Effect of Topical Nasal Anesthetic on Comfort and Swallowing in High‐Resolution Impedance Manometry

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