Unsedated transnasal ultrathin esophagogastroduodenoscopy may provide betterdiagnostic performance in gastroesophageal reflux disease

Abstract

Transnasal ultrathin esophagogastroduodenoscopy (N-EGD) with less gagging reflexes under non-sedation is likely suitable for the diagnosis of gastroesophageal reflux disease (GERD), however, N-EGD might have drawbacks, including its low image resolution. Limited information is available regarding the diagnosability of N-EGD for GERD. We compared the utility and gagging reflexes of three different endoscopies, including N-EGD, ultrathin transoral EGD (UTO-EGD) and conventional oral EGD (CO-EGD), in the diagnosis of GERD. We performed screening endoscopy in 1580 patients (N-EGD n=727, UTO-EGD n=599, CO-EGD n=254) and compared the frequency distributions of the severity of reflux esophagitis, hiatus hernia, and Barrett's epithelium to estimate the diagnostic performance of each endoscopy. We also analyzed patients' tolerability of endoscopy by the subjective evaluation of gagging reflexes. In the diagnosis of reflux esophagitis and Barrett's epithelium, there was no significant difference in the frequency distributions of the severity of the diseases among three EGDs. However, the incidence of Barrett's epithelium was higher than that in the previous nationwide survey of GERD in Japan. The evaluated size of hiatus hernia was smaller in N-EGD than in two other peroral endoscopies. The size of hiatus hernia correlated significantly with severity of gagging reflexes that was also lowest when diagnosed with N-EGD. N-EGD had an equivalent performance in the diagnosis of reflux esophagitis and Barrett's epithelium compared with CO-EGD. Enlargement of hiatus hernia induced by gagging reflexes was minimal in N-EGD, resulting in its better performance in the diagnosis of Barrett's epithelium.

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

“…Diagnostic yield was similar in both groups (Table ). This is in agreement with current literature for the detection of Barrett's oesophagus (BO), gastric cancer, and gastro‐oesophageal reflux associated diseases . Other studies, although consisting of small numbers, found that ultrathin endoscopes had similar diagnostic abilities .…”

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

“…Studies assessing concordance rates between transnasal esophagoscopy and standard endoscopy demonstrate moderate to good agreement in findings between the two techniques. [7–11]…”

“…[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.…”

Transnasal endoscopy: no gagging no panic!

“…In previous literature, the diagnostic yield had been found to be similar for the detection of Barrett's oesophagus (BO) and gastric cancer 5 44 45. It has been found to have better performance than oral OGD in the diagnosis of GORD-associated diseases in one paper 46. There has been increasing focus recently on the use of TNE as a screening tool especially for BO and early gastric and oesophageal malignancies.…”

“…The majority of these found better patient tolerance rates in the TNE group based on patient tolerance questionnaires 8 18 20 22 33–36. Patients have greater satisfaction and acceptability4 8 9 20 34–36 and are to be more likely to undergo TNE in the future. They also report a significant reduction in gagging20 37 and in some studies discomfort22 34 (see table 1).…”