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

Abstract

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.

Transnasal endoscopy: moving from endoscopy to the clinical outpatient–blue sky thinking in oesophageal testing

“…Existing literature has previously demonstrated that TNE is a comparable alternative to c-OGD as a diagnostic modality for numerous GI pathologies 5. Here, the inlet patch detection, a proposed surrogate of endoscopic quality, was 5.7% and comparable with the background rate from c-OGD,15 which suggests a similar degree of mucosal inspection quality.…”

“…Transnasal endoscopy (TNE) uses an ultra-thin endoscope of less than 6 mm diameter via the nasal route and is typically performed with the patient sitting upright. This offers an elegant solution to several problems facing endoscopy services in the post-COVID-19 era 5. As an unsedated procedure that bypasses the tongue, palate and uvula, TNE minimises stimulation of the gag reflex6 and offers excellent patient tolerability while the absence of sedation is cost-saving in terms of equipment, monitoring, and nursing resources during and after the procedure.…”

Reducing the environmental footprint of gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement

“…Thus, the benefits of this strategy in all scenarios should not be entirely assumed, especially for high-tech less invasive tests that require intense manufacturing and processing. Until further data are available, ESGE-ESGENA encourage less invasive tests for the indications endorsed by evidence-based clinical guidelines (▶ Table 4 [48][49][50][51][52][53][54][55][56]).…”

A single-center prospective study on pain alleviation during peroral upper endoscopy with an ultrathin endoscope

“…Transnasal endoscopy results in less pain without the use of sedatives as it induces the gag re ex to a lesser extent than peroral endoscopy with a normal-diameter endoscope (3)(4)(5)(6)(7)(8)(9)(10)(11). A suppressed gag re ex is useful during the Coronavirus disease-19 pandemic as it limits the spread of infection via airborne droplets (12). In addition, transnasal endoscopy does not signi cantly affect the patient's hemodynamics, minimizing the burden on the patient (13)(14).…”