Transnasal Endoscopy is Preferred by Transoral Endoscopy Experienced Patients

Abstract

Background & Aims: Both unsedated transoral endoscopy (TOE) and sedated TOE have some drawbacks in clinical practice. Unsedated transnasal endoscopy (TNE) has been suggested as an alternative to both methods. This study aimed to determine the advantages of TNE in patients who have previously undergone unsedated conventional TOE.Methods: Patients who had received an unsedated TOE in the last 12 months and were scheduled for a second upper endoscopy were included. They were randomized to undergo either unsedated TOE, using a standard endoscope, or unsedated TNE, using an ultrathin endoscope. Post-procedure, patients were asked to complete a questionnaire to assess pain, discomfort and acceptability of the procedure, and to compare the current procedure with their previous unsedated TOE. Endoscope insertion rate, procedure duration, and side-effects were recorded.Results: Each group included 50 patients. With the exception of nasal pain, the tolerability and acceptance were significantly greater in the unsedated TNE group. Significantly more TNE patients (82%) found the current endoscopic procedure to be better than their previous TOE when compared with patients who had received a second TOE (12%). A repeat procedure was significantly more acceptable for TNE patients when compared to the TOE group (68% vs.16%). The duration of endoscopy was significantly shorter in TOE than in TNE (p<0.05). Endoscope insertion failed in 4% and mild epistaxis was observed in 4% of TNE patients.Conclusion: Unsedated TNE was better tolerated in endoscopy experienced patients when compared with unsedated TOE. The majority of patients found TNE more acceptable and preferable to TOE, suggesting that TNE should become a more common practice in clinics when applicable.

Randomised clinical study: comparison of acceptability, patient tolerance, cardiac stress and endoscopic views in transnasal and transoral endoscopy under local anaesthetic

“…These advantages imply that TNE is ideal for screening and surveillance programmes (varices or Barrett's) as it is not uncommon for such patients to become increasingly anxious after multiple repeat endoscopies. A recent small randomised trial from Turkey with similar design to our study which included endoscopy‐experienced patients also confirmed that TNE was better tolerated when compared with unsedated standard endoscopy …”

“…Complications reported in other studies included self‐limited epistaxis (0.85–2%), vasovagal events (0.3%), and a single oesophageal perforation . No complications were reported in this study.…”

“…Failure to intubate the nose is limiting factor and has been reported in 3–8% of patients . In our study, two TNE procedures failed, but were successful transorally using the ultrathin endoscope.…”

Necessity of transnasal gastroscopy in routine diagnostics: a patient-centred requirement analysis

“…Unsedated peroral gastroscopy (ns-oEGD) can increase patients’ discomfort, which may reduce the overall quality of the examination 15 16…”

“…In numerous publications, nEGD has been described as a promising alternative, as it reduces cardiac stress level,18 shows good patient tolerance,5 14 16 19–25 leads to less gagging,18 26 and, at the same time, is effective and safe 27 28. Further studies have shown a high rate of completed procedures as well as reselection of nEGD in patients, who experienced the unsedated method before 16 27 29. According to a review on Japanese studies by Tatsumi et al , epistaxis is a main complication in nEGD (0%–5%) 30…”