Trial of Transnasal Esophagogastroduodenoscopy

Abstract

Background: Esophagogastroduodenoscopy (EGD) is conventionally performed transorally, although this is often a rather unpleasant experience for the patient. In the present study, we examined the merits and demerits of transnasal EGD. Materials and Methods: We used two types of small-diameter endoscope, produced by Olympus Co. and Fujinon Toshiba ES Systems Co., Ltd. Results: Transnasal EGD was performed successfully in 98.8% (955/967) of patients examined. When questioned about premedication and the degree of discomfort, the great majority of patients stated that transnasal EGD was more comfortable than a transoral procedure. The incidences of nausea and vomiting were low at 8.6% (82/955) and 0.8% (8/955), respectively. Other identified adverse reactions were nasal pain in 42.9% (415/967) of patients, and epistaxis in 1.1% (11/ 967). The average time taken for transnasal EGD was 8.2 ± 0.7 min, approximately 1 min longer than for the transoral method. Conclusion: Transnasal EGD is less stressful to patients than transoral EGD, and is a feasible and safe alternative.

Current Status and Evaluation of Transnasal Esophagogastroduodenoscopy

“…In Japan, completion rates for unsedated transnasal EGD are comparable and relatively high in institutes with a high skill of transnasal insertion. Abe and Miyaoka 2 reported that a successful transnasal insertion rate was 98.8% using both 5.2‐mm and 5.9‐mm scopes in a Japanese population whose gender and ages were not reported. The transnasal insertion rate may depend on differences of individual sensation and nasal cavity size or anesthetic and endoscopic procedures carried out in each case.…”

“…Although dramatic developments in endoscopic technology have made ultrathin videoscopes of improved quality for the Japanese market since 2002, there are still concerns when ultrathin videoscopes are inferior to standard videoscopes, regarding factors such as quality of image, maneuverability and biopsy performance. In Japan, for nasal anesthesia, one of the following methods is usually applied: lidocaine spray, 2 insertion of a catheter coated with lidocaine, 3 or a combination of both methods. However it is applied, the total amount of lidocaine should be limited to less than 200 mg to avoid an overdose of anesthetic agent.…”

Classification of patients who experience a higher distress level to transoral esophagogastroduodenoscopy than to transnasal esophagogastroduodenoscopy

“…Furthermore, the technical feasibility of small‐caliber EGD has been argued as completion rates. In Japanese institutes with more experience of transnasal insertion, a successful TN‐EGD rate of 98.8% has especially been reported using 5.2‐ and 5.9‐mm scopes, which is comparable to our results . In Japan, completion rates for unsedated TN‐EGD are thought to be comparable to those of sedated TO‐EGD.…”

Topical anesthesia for transnasal esophagogastroduodenoscopy: Spray, applicator, or both?

“…Moreover, a gauze pledget method was shown to be effective for nasal anesthesia in TN‐EGD . In Japan, one of the following methods has been used as nasal anesthesia: lidocaine spray method, insertion of lidocaine applied applicator, and a combination of both …”