Utility and Stability of Transnasal Endoscopy for Examination of the Pharynx - A Prospective Study and Comparison with Transoral Endoscopy

Abstract

Objective: Transnasal endoscopy may be used to observe the head and neck part readily without excessive reflexes. We aimed to evaluate the utility and stability of transnasal esophagogastroduodenoscopy (TN-EGD) in comparison with transoral EGD (TO-EGD) for observation of the pharynx.Study Design: Prospective studyMethods: A total of 497 patients received unsedated TN-EGD with a 5.5 mm diameter endoscope or unsedated TO-EGD with endoscopes of 6.5 mm, 7.9 mm and 9.2 mm diameter. The rate of completion of pharyngeal observation and numbers of gag reflexes and cough reflexes were recorded.Results: TN-EGD was performed in 175 patients and TO-EGD was performed in 322 patients. Pharyngeal observation was completed in 173 patients (98.9%) in the TN-EGD group and 235 patients (73.2%) in the TO-EGD group, a significant difference (p<0.001). The TN-EGD group had a low rate of occurrence of gag reflex (0.57%), in contrast, 28.3% of the TO-EGD group had a gag reflex, a significant difference (p<0.01). Multivariable analyses revealed that the use of TN-EGD was the only predictive factor for completion of pharyngeal observation (p<0.0001).Conclusions: TN-EGD is ideally suited to observation of the pharynx by unsedated EGD.

Office-based procedures for diagnosis and treatment of esophageal pathology

“…Inspection of the mucosa is performed by pulling the endoscope slowly upward in a circumferential manner. For inspection of the esophagus, air is blown through the working channel to open the esophagus . The gastrointestinal junction is difficult to inspect and requires more time.…”

“…Although it is more frequently caused during rigid esophagoscopy, 2 cases of proximal esophageal perforation have occurred during transnasal esophagoscopy . The performance of unsedated transnasal esophagoscopy causes less increase in blood pressure and heart rate compared to the transoral method …”

Pethidine hydrochloride is a better sedation method for pharyngeal observation by transoral endoscopy compared with no sedation and midazolam

“…Recently, transnasal endoscopy was reported to be useful for pharyngeal observation . In these studies, pharyngeal observation images by transnasal endoscopy were better than those by transoral endoscopy, and gag reflex and adverse events in transnasal endoscopy were lower than those in transoral endoscopy.…”

“…Transnasal endoscopy can suppress the gag reflex and may provide the ideal condition for pharyngeal observation . However transnasal endoscopy does not have a magnifying function and usually has lower resolution than transoral endoscopy.…”

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

“…Unsedated transnasal esophago‐gastro‐duodenoscopy (UT‐EGD) is superior to peroral EGD (P‐EGD) because of lesser gagging and better procedural tolerance . It may be used to observe the pharynx and for diagnosing hypopharyngeal cancer readily without excessive reflexes . UT‐EGD is thus an alternative to sedated P‐EGD, especially for those who are at risk under intravenous sedation.…”