Unsedated Transnasal Endoscopy: A Canadian Experience in Daily Practice

Cho, Sarah; Arya, Naveen; Swan, Katherine; Cirocco, Maria; Kandel, Gabor; Kortan, Paul P.; Marcon, Norman E.

doi:10.1155/2008/514297

Cited by 38 publications

(54 citation statements)

References 18 publications

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“…Four studies have assessed unsedated small-caliber transnasal esophagoscopy in North America. [7, 9, 10, 20] In general, these studies demonstrate that transnasal esophagoscopy is well tolerated. However, these studies are limited by small sample sizes and/or specialized populations with a history of esophageal symptoms or Barrett’s esophagus.…”

Section: Discussionmentioning

confidence: 66%

“…[6–16] The sensitivity of detecting esophageal abnormalities with unsedated small-caliber esophagoscopy is comparable to conventional upper endoscopy. [7–11] Although unsedated transnasal esophagoscopy is well tolerated in cultures less accustomed to conscious sedation,[11, 17–20] studies in North America have been limited by small sample sizes and have been performed in specialized populations selected for either esophageal symptoms or Barrett’s esophagus. [9, 10] Moreover, most studies in the U.S. have been limited to selected populations in referral settings.…”

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confidence: 99%

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Feasibility, safety, acceptability, and yield of office-based, screening transnasal esophagoscopy (with video)

Peery¹,

Hoppo²,

Garman³

et al. 2012

Gastrointestinal Endoscopy

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Background Endoscopic screening for esophageal neoplasia can identify patients eligible for early intervention for pre-cancerous lesions. Unsedated transnasal esophagoscopy may provide an efficient and accurate endoscopic assessment with fewer risks and less cost compared to conventional upper endoscopy. Objective To assess the feasibility, safety, acceptability and yield of unsedated transnasal esophagoscopy in a primary care population. Design Multi-center, prospective, cross-sectional study. Setting Two outpatient tertiary centers. Patients General medical clinic population between the ages of 40 and 85. Interventions Unsedated, office-based transnasal esophagoscopy. Main outcomes measurements 1) Procedure yield, 2) Completeness of examination, 3) Procedure length, 4) Adverse events and complications, 5) Choking, gagging, pain or anxiety during the examination, and 6) Overall tolerability Results Four hundred and twenty-six participants (mean age 55.8 ± 9.5, 43% male) enrolled in the study, and 422 (99%) completed the examination. Mean examination time was 3.7 ± 1.8 minutes. There were no serious adverse events and 12 participants (2.8%) reported minor complications. Participants reported minimal choking, gagging, pain or anxiety. The examination was well tolerated by most participants. Overall, 38% of subjects had an esophageal finding that changed management (34% erosive esophagitis, 4% Barrett’s esophagus). Limitations Nonrandomized study; tertiary centers only; self-selected population with a large proportion reporting esophageal symptoms. Conclusions Unsedated transnasal esophagoscopy is a feasible, safe, and well-tolerated method to screen for esophageal disease in a primary care population. Endoscopic findings are common in this patient population.

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Section: Discussionmentioning

confidence: 66%

mentioning

confidence: 99%

Feasibility, safety, acceptability, and yield of office-based, screening transnasal esophagoscopy (with video)

Peery¹,

Hoppo²,

Garman³

et al. 2012

Gastrointestinal Endoscopy

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“…24–27 This guideline increased attention to cost containment, and the recent upswing in interest in esophageal diseases led to renewed interest in this technique. 25,28–30 A recent study also demonstrated the utility of TNE in adults with Barrett’s esophagus. 27,28,31 To date, only 1 study evaluated unsedated transoral endoscopy in children and concluded that it improved time and safety in assessing 21 children for evaluation of abdominal pain, dyspepsia, and dysphagia.…”

Section: Discussionmentioning

confidence: 98%

“…For example, a large Canadian study by Cho et al 30 evaluating 231 patients with an average age of 57 years for routine TNE found that TNE was well tolerated, safe, and feasible. This study was different, however, in that the patients were primarily adults, the endoscope used was larger (5.3 mm), and duodenal intubation was performed.…”

Section: Discussionmentioning

confidence: 99%

Unsedated transnasal esophagoscopy for monitoring therapy in pediatric eosinophilic esophagitis

Friedlander

DeBoer

Soden

et al. 2016

Gastrointestinal Endoscopy

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Background and Aims Unsedated transnasal endoscopy (TNE) is safer and less costly than sedated EGD. The aim of this study was to evaluate the performance of TNE with biopsies in monitoring the esophageal mucosa of pediatric patients with eosinophilic esophagitis. Methods Patients between 8 and 17 years of age with eosinophilic esophagitis and their parents were enrolled. Unsedated TNE was performed. A 2.8-mm (1.2-mm channel) or a 4-mm flexible bronchoscope (2-mm channel) was used, and esophageal biopsy specimens were obtained. Biopsy specimen analysis, duration, adverse events, and billing charges of TNE were assessed. Immediately after TNE and a minimum of 2 weeks later, a modified Group Health Association of America 9 survey and a preference questionnaire were completed, respectively. Results Twenty-one of 22 enrolled patients underwent TNE. TNE was performed with no serious adverse events. Histopathological analysis revealed 0 eosinophils per high-power field (n = 12), fewer than 15 eosinophils per high-power field (n = 4), and more than 15 eosinophils per high-power field (n = 5). The total epithelial surface area of mucosal biopsy samples from either TNE Forceps (1.2 mm or 2 mm biopsy channel forceps) compared with those obtained during the subject’s previous EGD by using standard endoscopic forceps was not statistically different (P = .308 [1.2 mm]/P = .492 [2 mm]). All parents and 76.2% of subjects would undergo the TNE again. TNE was preferred over EGD by 85.7% of parents and 52.4% of subjects. The modified Group Health Association of America 9 survey revealed a high degree of satisfaction (average, 43.19 ± 2.6; maximum score, 45). Charges associated with TNE were 60.1% lower than for previous EGDs. Conclusions Unsedated TNE is an effective, lower-cost procedure for monitoring the esophageal mucosa of children with eosinophilic esophagitis.

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“…Unsedated transnasal esophago‐gastro‐duodenoscopy has become more popular in many countries given the adverse effects and costs of intravenous sedation in sedated P‐EGD . Therefore, a well prepared anesthesia is very important.…”

Section: Introductionmentioning

confidence: 99%

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

Lei

Lin

et al. 2017

J of Gastro and Hepatol

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Unsedated Transnasal Endoscopy: A Canadian Experience in Daily Practice

Cited by 38 publications

References 18 publications

Feasibility, safety, acceptability, and yield of office-based, screening transnasal esophagoscopy (with video)

Feasibility, safety, acceptability, and yield of office-based, screening transnasal esophagoscopy (with video)

Unsedated transnasal esophagoscopy for monitoring therapy in pediatric eosinophilic esophagitis

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

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