Study of Ultraslim Unsedated Transnasal Esophagogastroduodenoscopy 4.9 mm GIF-N180 in Ambulatory Office Setting: Case Series Report on 207 Patients

Abstract

Purpose: Previous reports with transnasal endoscopy were in the tertiary non-ambulatory office setting with the older version of the scope, which had higher failure rates and more patient inconvenience. Also, previous literature has shown that endoscope diameter is an important factor for transnasal tolerance. Here, we look at the efficacy of the 4.9 mm diameter slim sight scope in high-risk patient populations and will analyze the safety in the outpatient ambulatory office setting. Methods: 207 patients in the ambulatory physician office setting were evaluated by unsedated transnasal endoscopy using the 4.9 mm diameter GIF-N180 under local nasal anesthesia. We took note of the subject and preliminary indications suggesting need for endoscopy. Success was defined according the ability to accurately identify endoscopic findings and pathology, successful deep intubation into the second part of the duodenum, and adequately procuring biopsy specimens in each patient using a 2 mm biopsy forceps. Safety and morbidity was evaluated by monitoring complications during the endoscopy, specifically epistaxis, and assessing overall patient tolerability, and satisfaction. Results: The use of the new 4.9 mm transnasal endoscopy GIF-N180 was successful in all but one of the 207 patients, providing a 99% success rate. Additionally, out of the 206 completed cases there were no cardiorespiratory complications or any reporting of epistaxis. This provided a 0% safety with the use of the GIF-N180. One patient where the procedure was unsuccessful has an anatomically very narrow nasal passage. Conclusion: The use of the new 4.9 mm diameter GIF-N180 transnasal endoscope allows accurate placement of the tube into the second part of the duodenum and is superior to older models in terms of safety, tolerability and efficacy. The current literature mentions a complication rate of 0-1.6% in patients and 22% of cases have epistaxis when using the wider 5.9 mm diameter trans nasal endoscopes. This morbidity data is much worse compared to the 0% morbidity in our study using the 4.9mm diameter GIF-N180 OLYMPUS Scope. Therefore, our transnasal endoscopy data represents a safe and cost effective alternative to the conventional esophagogastroduodenoscopy in the evaluation of upper digestive tract diseases in the ambulatory physician office setting.