Ultrathin Transnasal Endoscopy: Experience of Six Hundred Cases

Abstract

Background and Purpose: Esophagogastroduodenoscopy (EGD) can be performed transnasally by using small-diameter endoscopes. We analysed our case series to evaluate the feasibility and tolerance of diagnostic transnasal EGD in daily practice. Methods: Patients by indications or referred for transnasal ultrathin EGD (UT-EGD) underwent unsedated transnasal UT-EGD by either one of the Fujinon transnasal endoscopes EG-470N5 and EG-530N. We prospectively evaluated the success, failure, and complication rates of UT-EGD. Patients who previously had undergone conventional peroral EGD (CP-EGD) were queried as to which procedure they preferred. Results: Between September 2005 and March 2006, 600 patients underwent transnasal UT-EGD with an average age of 46.3±1.7 years (range 18-89 years), 58% being female. Transnasal UT-EGD was feasible in 97.3% of the patients. Sixteen procedures (2.6%) were failed due to unsuccessful transnasal insertion through both nostrils (4 women, 4 men), patient's request for conversion to peroral route (4 women), and unbearable nasal pain (3 women, 1 man). Although it was not related to body weight, failure of transnasal UT-EGD was more frequent in patients of younger age (36.8±1.7 years vs. 55.8±1.4 years, p＜0.05) and among women than men (68.75% vs. 31.25%, p＜0.05). Side effects included epistaxis (2.3%), mild nasal pain after procedure (1.6%), transient light-headedness (0.9%), and mucus discharge (0.6%). Of the 291 patients (48.5%) who previously had undergone unsedated CP-EGD, 93.1% preferred transnasal UT-EGD. Conclusions: Transnasal UT-EGD was well tolerated and acceptable in the majority of patients. Its high success rate, low failure rate, and low complication rate make UT-EGD an acceptable alternative to CP-EGD in certain situations such as in those with ”endoscophobia” and esophageal stricture.