Transnasal Gastroscopy Research Articles

Association of serum pepsinogen with degree of gastric mucosal atrophy in an asymptomatic population.

BACKGROUNDAtrophic gastritis is a precancerous lesion of the stomach. It has been reported that pepsinogen (PG) can reflect the morphology and function of the gastric mucosa, and it is therefore used as a marker for the early diagnosis of atrophic gastritis.AIMTo evaluate the diagnostic value of serum PG for degree of gastric mucosal atrophy in asymptomatic Chinese upon physical examination.METHODSMedical data were collected from subjects who underwent transnasal gastroscopy between October 2016 and October 2018. For each study subject, serum PG levels and presence of Helicobacter pylori (H. pylori) infection were investigated. Pathology was evaluated using the Operative Link for Gastritis Assessment (OLGA) classification and Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) systems. All statistical analyses were carried out using SPSS statistical software.RESULTSA total of 2256 subjects were enrolled and 1922 cases were finally included in the study. Based on the OLGA grading system, the levels of PGI were slightly decreased, while those of PGII were slightly increased. The PGI/PGII ratio (PGR) was reduced with increasing atrophy. The association between PG and OLGA grading was higher compared with that between PG and the OLGIM grading system. Compared with the OLGA-0 group, a statistically significant difference was observed in the mean age of OLGA-I, III, and IV groups (P < 0.05). In the H. pylori-positive subjects, the PGR levels were notably lower in the OLGA-I, II, and III groups compared with the OLGA-0 group (P < 0.05). H. pylori-positive subjects exhibited significantly higher PGI and PGII serum levels and a significantly lower PGR compared with H. pylori-negative patients in different OLGA groups (P < 0.05). CONCLUSIONSerum PG levels may represent a non-invasive screening marker for gastric mucosal atrophy in asymptomatic subjects.

A comparative study on transnasal gastroscopy and conventional gastroscopy for percutaneous endoscopic pancreatic necrosectomy

Objective To compare the therapeutic value of transnasal gastroscopy and conventional gastroscopy for infective pancreatic necrosis(IPN) through percutaneous endoscopic necrosectomy(PEN). Methods A total of 24 IPN patients who received PEN for IPN from December 2015 to March 2019 were divided into the conventional gastroscopy group (n=15) and the transnasal gastroscopy group (n=9). The clinical therapeutic indicators such as vital signs, APACHE Ⅱ score changes, operation duration, difference in preoperative and postoperative volumes of peripancreatic necrosis and other indicators were compared between the two groups. Results There was no significant difference in the variation curve fitting of APACHE Ⅱ scores between the two groups (t=0.378, P=0.710). The operation time of the transnasal gastroscopy group was significantly shorter than that of the conventional gastroscopy group (119.7±47.4 min VS 172.8±56.2 min, P=0.018). Peripancreatic necrotic volume significantly decreased after operation in the transnasal gastroscopy group (404.03±170.73 mL VS 468.9±137.37 mL, P=0.002), and in the conventional gastroscopy group (499.44±227.17 mL VS 722.50±292.96 mL, P<0.001). There was no significant difference in the decrease extent in the conventional gastroscopy group and the transnasal gastroscopy group (223.06±212.92 mL VS 64.87±54.94 mL, P= 0.094). Conclusion On the condition of poor drainage of percutaneous catheter drainage, PEN can significantly reduce the range of necrotic lesions. Transnasal gastroscopy has the advantages in operation time in PEN and clearing deep abscess cavities over conventional gastroscopy. Key words: Pancreatitis; Percutaneous endoscopic necrosectomy; Infective pancreatic necrosis

Necessity of transnasal gastroscopy in routine diagnostics: a patient-centred requirement analysis

IntroductionNumerous indications require regular upper gastrointestinal endoscopy (oesophagogastroduodenoscopy; EGD) in outpatients. In most cases, peroral gastroscopy is performed. The aim of this study was to evaluate the need of transnasal...

Clinical comparative study on Nitrous Oxide inhalation versus intravenous propofol and Midazolam sedation in Transnasal Gastroscopy.

Objective:To investigate the Clinical practice value of nitrous oxide inhalation and intravenous propofol and midazolam sedation in transnasal gastroscopy.Method:From December 2012 to April 2014, two hundred patients receiving painless transnasal gastroscopy on a voluntary basis were selected in Endoscopy center, The First People’s Hospital of GuiYang. Patients were divided into two groups: Group-1 consisted of one hundred patients sedated by nitrous oxide inhalation and Group-2 consisted of one hundred patients sedated by intravenous propofol and midazolam. Patients were then examined by transnasal gastroscopy. Patient blood pressure, heart rate, pulse rate and oxygen saturation before, during and after gastroscopy were recorded for both groups. The duration of the gastroscopy and the time of awakening were also recorded. After examination, the patients were asked to assess the level of discomfort experiences during the gastroscopy procedure.Results:All patients successfully underwent the transnasal gastroscopy. There were 57 males and 43 females in the nitrous oxide inhalation group with an average age of 43.11±8.27 years. The average duration of examination and time of awaking in the nitrous oxide inhalation group was of 152.7±9.80 secs and 50±7.89 secs respectively. For the intravenous propofol and midazolam sedation group, there were 53 males and 47 females with an average age of 41.26±7.98 years. The average duration of examination and time of awaking in the intravenous propofol and midazolam sedation group was of 149.07±10.25 seconds and 390±20.89# seconds respectively. The two groups showed no significant difference in the duration of examination. There was no difference in the age or sex. The former had a less significant impact on heart rate, oxygen saturation and blood pressure, while the intravenous propofol and midazolam sedation decreased blood pressure dramatically and this effect persisted after examination.Conclusion:Nitrous oxide inhalation has higher safety and tolerance with a brighter application prospect for transnasal gastroscopy.

PTU-054 Transnasal Gastroscopy – Are The Biopsies Suitable For Barrett’s Surveillance?

IntroductionTransnasal gastroscopy is a far more acceptable form of gastroscopy to the patient, with benefits including reduced gagging, ability to communicate during the procedure, greater flexibility of endoscope allowing easier...

Mo1831 Trans-Nasal Gastroscopy Without Sedation for Eosinophilic Esophagitis; Safe, Effective and the Ideal Method of Assessment?

Introduction: Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disorder triggered by food antigens. A six-food elimination diet (SFED) achieves histological remission in around 75% of adult EoE patients. The most common food triggers identified have been milk, wheat, egg and soy and/or legumes, with a minor role for nuts and fish/ seafood. Less restrictive dietary interventions might improve patient acceptance of dietary limitations and reduce the number of endoscopies and overall time to complete the food reintroduction process. Methods: Prospective multicenter study in consecutive adult patients with EoE, defined by consensus guidelines. An optimized four-food elimination diet (FFED) (dairy products, gluten, egg and legumes, including soy and peanut) was designed to avoid to the maximum cross-reactivity between food allergens. All patients underwent histological re-evaluation after 6 weeks on FFED. Response to FFED was defined by clinical and histological ( 50% reduction in their peak eosinophil density, whereas clinical and histological remission was accomplished in 22 patients (51%). To date, 10 patients have finished the food reintroduction process (5 patients with a single food trigger, 5 patients with two food triggers). The most common causative food allergens have been dairy (58%), egg (50%), gluten (26%) and legumes (20%). Among 21 non-responders to FFED, 12 patients underwent rescue SFED, of whom 6 (50%) achieved clinico-pathological remission. Conclusion: Clinico-pathologic remission was accomplished in 50% of EoE patients following a FFED and in 50% of FFED non-responders undergoing rescue SFED. FFED is a cheaper, faster and less inconvenient dietary intervention, effective in 2 out of every 3 adult EoE patients responder to SFED.

A comparative study on a new transnasal gastroscopy and routine gastroscopy

Objective To investigate the clinical value of new transnasal Fujifilm EG-530-NW electronic gastroscope. Methods A total of 295 patients who underwent gastroscopy were randomly divided into 2 groups to receive examination by routine endoscope （ n = 172 ） or Fujifilm EG-530-NW transnasal endo- scope （n = 123）. The fluctuation of heart rate, blood pressure and compliance during the examination were recorded and compared between the two groups. Results The new Fujifilm EG-530-NW could obtain clear images with same quality of routine gastroscope. The heart rate change and visual analog pain score in pa- tients from EG-530-NW gastroscope group were significantly lower than those of routine gastroscope group （ P 〈 0.05 ）. No significant difference in blood pressure fluctuation was observed between the two groups. In patients older than 50 years, the fluctuations of heart rate and blood pressure in EG-530-NW group were significantly less than those of routine gastroscope group. Conclusion Fujifilm EG-530-NW gastroscope can get high quality image with less influence on heart rate and blood pressure fluctuation, which is more signifi- cant in older patients. Key words: Endoscopy; Transnasal gastroscopy; Routine gastroscopy; Comparative study

Direct Cholangioscopy: New Horizons for Complex Intraductal Treatments Under Direct High-Resolution Visualization

Direct Cholangioscopy: New Horizons for Complex Intraductal Treatments Under Direct High-Resolution Visualization

A randomized controlled study on nitrous oxide-sedated transnasal endoscopy for high risk patients of intravenous anesthesia

Objective The efficacy and safety of nitrous oxide-sedated transnasal gastroscopy for high-risk patients of intravenous anesthesia were evaluated. Methods A total of 157 patients were randomly assigned to the nitrous oxide group （n = 80） and the oxygen group （n = 77 ）. Heart rate, blood oxygen satu ration, blood pressure and electrocardiogram were monitored. Complications in both groups were recorded. Satisfaction degrees of patients and endoscopy physicians were evaluated with a questionnaire and visual analog scale （VAS） score. The questionnaire questions for physicians included the procedure evaluation （steady, ok, unsteady）. Patients＇ questionnaire questions included discomfort （light, moderate, severe）, the patients＇ tolerance （fine, moderate, weak） and the patients＇ willingness to undergo a second procedure. Statistical analysis was performed between the two groups. Results Six of the toal 157 patients were removed be cause of the operation failure （difficulty in access to nasal cavity in 5 patients and nose bleeding in one patient）, 151 patients underwent the transnasal gastroscopy successfully and completed the questionnaires. In experimental group, there were 37 males and 41 females （mean age was 67.7 years, ranging 16-88 years, 7 patients were grade 1 of ASA, 61 were grade 2, and 11 were grade 3）. In the control group, there were 36 males and 37 females （mean age was 67. 9 years, ranging 17-86 years, 6 patients were grade 1 of ASA, 57 were grade 2, and 9 were grade 3）. There was no differences in sex, average age and ASA grade between the two groups （P 〉 0. 05 ）. There was no difference in the mean operation time between the two groups, either （200. 1 s vs 200. 3 s） （P 〉 0.05 ）. There were no significant differences between the two groups in changes of blood oxygen saturation, blood pressure, electrocardiogram and complication rates （P 〉 0.05 ）. Both physicians＇ and patients＇ positive evaluations of the experimental group were more than that of the con- trol （P 〈 0. 05）, while physicians＇ and patients＇ negative evaluations of the experimental group were less than the control （P 〈 0. 05）. VAS of physicians＇ satisfaction in the experimental group was higher than that of the control group （84 vs 70, t = 14. 67, P 〈0.05）, and VAS of patients＇ satisfaction in the experimental group was superior to the control group （82 vs 71, t = 11.56, P 〈0.05）. The number of patients willing to undergo a second procedure in the experimental group was higher than that of the control （89. 7% vs 69. 9%, P 〈 0.05）. Conclusion Nitrous oxide-sedated transnasat endoscopy is an effective and safe procedure for high risk patients of intravenous anesthesia. Key words: Nitrous oxide-sedated; Transnasal endoscopy

Clinical application anlysis on 175 cases of nasal endoscopy examination

Objective To explorethe clinical value of unsedated transnasal gastroscopy. Methods The vital signs,tolerance and biopsy data of 175 patients underwent unsedated transnasal gastroscopy in our hospital were analyzed. Results Among 175 cases, there were no discernible effect on patient' s heart rate, blood pressure and degree of blood oxygen saturation. All patients had good tolerance.175 examples by a complete review of cases (97.2%) with a complete look into the mirror,the 175 example,pathological and correspond to the performance of the 161 example (92.2%). Conclusion The unsedated transnasal gastroscopy can be performed in non-sedating situation ,and it is safe and feasible for the elder patients with difficulty in opening mouth or cardiac insufficiency, and for the patients scared of conventional endoscope. But the uncomfortable feel or bleeding of nasals is the insufficiency. Key words: N-sedating; Transnasal gastroscopy; Analysis

Remaining in an Upright Position Is Suboptimal for Transnasal Gastroscopy

To the Editor: We read with interest the article by Yu et al. (1), which recommended adoption of a sitting position in transnasal gastroscopy as a new approach. They performed transnasal esophagogastroduodenoscopy (EGD) in a woman remaining in the sitting position because she had severe cough in the decumbent position by conventional peroral EGD. Her cough may be most likely due to gag reflex induced by peroral EGD or laryngopharyngeal reflex. Previous studies showed that unsedated transnasal pharyngoesophagogastroduodenoscopy induced less gag reflex and the pharynx can be meticulously examined with this highly tolerable route (2,3). Thus, this “cough problem” in this woman might have been simply resolved by transnasal EGD without adopting the sitting position.

Adoption of a Sitting Position in Transnasal Gastroscopy

Adoption of a Sitting Position in Transnasal Gastroscopy

Adoption of a Sitting Position in Transnasal Gastroscopy: A New Approach

Yu, Chaohui MD, PhD1; Shen, Zhe MD1; Zhang, Chaonan MD1; Fang, Ying MD1; Li, Youming MD, PhD1 Author Information

Early Experience with Unsedated Ultrathin 4.9 mm Transnasal Gastroscopy: A Pilot Study

Unsedated transnasal gastroscopy is a technique with unverified clinical advantages. To evaluate the efficacy and procedure times with transnasal gastroscopy by physicians with no previous experience in transnasal endoscopy. Unsedated transnasal gastroscopy using 4.9 mm ultrathin transnasal gastroscopes with randomization to two different biopsy forceps was prospectively evaluated during a single day in January 2008. The outcomes included patient tolerance (scale: 1, no discomfort; 10, severe discomfort), physician technical assessment (1, excellent; 10, very poor), gastric biopsy quality, adverse events and procedure times. Twenty patients underwent transnasal gastroscopy. Nineteen patients (95%) successfully completed transnasal gastroscopy. The patient-reported mean (+/- SD) overall discomfort level during the procedure was 4.0+/-1.9 compared with a physician-estimated level of 3.2+/-1.7 (P=0.04). Only 10% (n=2) reported they would have preferred sedated over unsedated gastroscopy. Mean total encounter time from anesthesia to discharge was 33.5+/-9.3 min. The time from anesthesia to insertion was 7.0+/-5.3 min and from room exit to discharge 6.2+/-2.9 min. No patients who had gastric biopsies taken (zero of 14) had any of unacceptable quality. The only adverse event was distressing sensations (dyspnea, dizziness) in one patient that started during pre-endoscopy anesthetic application, persisting postendoscopy, but without any abnormalities in vital signs. Assuming the adverse event was a rare reaction, early experience with unsedated ultrathin transnasal gastroscopy was an efficient, effective and well-tolerated procedure for evaluation of the upper gastrointestinal tract.

Medical and Patient Oriented Research About Trans-Nasal Gastroscopy (T-EGD): First Multicenter (12 Hospitals) Italian Study in 1000 Patients

Background: nasal route for upper endoscopy was first considered by Shaker (Gastrointest Endosc, 1994) and proposed as routinely diagnostic and selected therapeutic procedure by Barberani (It.J.Gastroent.Hepat. 1998) with his innovative technique. Aim: 1) to evaluate safety, feasibility and satisfaction rate of T-EGD from both medical and patient points of view, focusing by a multivariate analysis on final judgement influencing criteria 2) to evaluate effect of aromatized lubrification gel (eucalyptus, lemon or rose Sapimed-Italy) on pts satisfaction rate. Methods: 1006 pts (576M,430F;range 16-99) underwent T-EGD performed. Pts were divided in three groups in relation to previous experience of T-EGD (C), oral-EGD (B) or no previous endoscopy (A). Medical satisfaction rate was evaluated analyzing pts collaboration during T-EGD and technical difficulties in nasal insertion;safety was evaluated by complication incidence, monitoring cardiac frequency and O2 saturation; pts satisfaction was evaluated considering nasal discomfort, vomiting, burping and choking by means analogical scale (1-10). Aromatized gel effect was evaluated monitoring satisfaction rate of group C-patients (previous T-EGD with neutral gel). T-EGD were performed by means of Fuji-Olympus-Pentax 6 mm video-endoscope. Statistical analysis were performed by χ2 test for proportion and one way analysis variants for continuous data (R. Marmo MD, Italy); p < 0.05 was considered statistically significant. Results: Pts collaboration was bad(8,5%), good (47,6%) excellent (43,9%). No problems in nasal insertion in 81,4%, mild in 11%, high in 7,6% without differences between sex. Pts discomfort at the insertion was none (17,3%) mild (63,5%) high (19,2%). No pO2 variation before, during and after examination while cardiac frequency increased 9% during T-EGD(p < 0,0005). Complications rate was 0,3% (1 vertigo,2 epistaxis spontaneously recovered). Mild tearing in 50% and sneeze 10%. Vomiting was present in only 9,1%, burping in 10,8%, choking in 2,5%. In 6,1% of the pts was evident. ENT pathology Final judgement of pts about T-EGD was positive in 92%. 90% of pts appreciated aromatized gel and eucalyptus was favourite; T-EGD was more comfortable than previous with neutral gel in 91% of C group pts. The correlation between collaboration, nasal discomfort, symptoms, difficulty of nasal insertion, emphasize 10% of pts with negative judgment about T-EGD related to nasal and pharyngeal high sensitivity. Conclusions: T-EGD high satisfaction and safety were confirmed by both medical and patient point of view and are emphasized by using aromatized gel; nasal and pharyngeal high sensitivity could explain 10% of unsatisfacted pts that need sedation.

Transnasal gastroscopy without sedation versus transoral gastroscopy under sedation: A randomised prospective study on accuracy, acceptability, feasibility and safety

Transnasal gastroscopy without sedation versus transoral gastroscopy under sedation: A randomised prospective study on accuracy, acceptability, feasibility and safety

Role of trans-nasal gastroscopy (T-EGD) in clinical management in ingested foreign bodies

Role of trans-nasal gastroscopy (T-EGD) in clinical management in ingested foreign bodies

Role of Trans-Nasal Gastroscopy (T-EGD) in Clinical Management in Ingested Foreign Bodies

Role of Trans-Nasal Gastroscopy (T-EGD) in Clinical Management in Ingested Foreign Bodies

Prevalence of Gastro-Oesophageal Reflux Disease (GORD) and Coeliac Disease (CD) in Patients with Oro-Dental Lesions (ERRE Study)

Background: Dental erosions are assessed complications of GORD and gingival aphtosis may be concurrent with CD.(#) Aim of this study was to investigate the prevalence of GORD and CD in patients with oro-dental lesions. Materials and Methods: Between september 2003 and 2004, 120 patients underwent dental examination for the first time by a senior dental physician and if positive were referred to our Gastroenterology Unit. Presence and localization of dental erosions was assessed by means of Eccles and Jenkins scale (A group). On the other hand were evaluated aphtoid lesions with a story of two events per month or more (B group). The A pts only if 40 years old or more, were directed to perform trans-nasal gastroscopy (TN-EGDS) and if negative 24 hours pH-metry; urea breath test (UBT) was tested. The B pts were requested to measure out anti-gliadin, anti-endomisium, anti-tissutal transglutaminase antibodies and if positive, to perform TN-EGDS with duodenal bioptic study. Results: In 41/120 patients (29.2%, M/F = 16/25, range 9-70 yy) oro-dental lesions were detected. 27/41 pts (M/F:10/17) underwent gastroenterological examination, 22(M/F:7/15) in A group and 5 in B group (M/F:3/2). In the A group 5 symptomatic pts refused EGDS and 1female was rejected because anorexic. 14/16 pts (87.5%, M/F:6/8 range 29-73 yy ma:43,43) had esophagitis or pathologic reflux at pH-metry; UBT was positive in only 1 pt. In the B group we detected 2 CD both UBT negative: 1M 25 and 1F 24 years old. Conclusions: Our preliminary experience suggest: 1) an high agreement between dental erosions and GORD. 2) gingival aphtosis is an accurate marker of CD. In the light of these results the role of the dentist could support the gastroenterologist's and the involvement of several specialists will make screening possible on a large scale in future. (#) Jarvinen V et Al. Caries Res. 1992;26(5):391-6.

Using the Video Endoscope Prototype Olympus XGIF-N160Y1 for Transnasal Gastroscopy: A Pilot Study of Feasibility and Tolerability

Background and Aim: The video endoscope Olympus XGif-N160Y1 (outer diameter:4.9 mm, total length:1410 mm, working length:1100 mm) is a prototype (PT) with only “up-down” movement, metallic distal tip and a deflexion capability of 210° up and 180° down. The aim of the study was to assess feasibility and tolerability of transnasal gastroscopy (TN) using this prototype. Methods: 50 consecutive patients eligible for TN were enrolled in the study (25 men, 25 female, age: 49 ± 17 years). InIclusion criteria were: indication for gastroscopy, history of prior conventional gastroscopy and age>14 years.