Introduction: In a patient population undergoing EGD, general anesthesia is commonly required to provide an optimal working environment for successful completion of endoscopic examination. We have revisited an old technique utilizing nasal airways to deliver oxygen and inhaled anesthetics for EGD and evaluated its effectiveness and safety profile. Methods: Two hundred charts of pediatric patients who have undergone EGD in our institution between 2001–2003 were identified. For our retrospective review, we selected 112 charts where EGD alone or in combination with another procedure (e.g, colonoscopy) were performed. Patients were anesthetized by either inhaled anesthetics alone, total intravenous anesthetics (TIVA), or a combination of both. The emphasis of our data collection was to compare the safety profile and efficiency of the nasal airway technique to other techniques by looking at the peri-procedure complication rates and operating room (OR) turnover times. Results: The age of patients ranged from 7 months to 20 years (mean, 9.8 years). Fifty-four were female (48%). The average time to leaving the OR was significantly lower in the nasal airway group compared to endotracheal intubation (p value <.001). Discharge times between our 3 comparison groups did not significantly differ. There were a total of 11 peri-operative adverse events among the three groups. No aspiration episodes occured and no event had long-lasting sequelae.Table 1Conclusion: In our study, nasal airway provided us with a satisfactory means of maintaining patent airway during EGD. The complication rate in the nasal airway group was lower than in other evaluated groups. The nasal airway group exhibited no increased risk of aspiration. Our findings suggest that a nasal airway method is a safe, non-invasive alternative to endotracheal intubation when used for EGD. OR turnover times were superior in the nasal airway group in comparison to patients being intubated. We also postulate that by providing oxygenation only via a nasal airway in combination with TIVA, one can minimize atmospheric pollution with inhaled anesthetics in the high volume endoscopy suite.