Unsedated Transnasal Esophagogastroduodenoscopy Research Articles

7119 Prospective evaluation of diagnostic transnasal esophagogastroduodenoscopy in daily practice: results from 1,000 consecutive patients.

Background: By using a pediatric endoscope, esophagogastroduodenoscopy can be performed through nasal route in adults. In order to evaluate this new procedure, we conducted a large prospective study to evaluate the feasibility and tolerance of diagnostic transnasal esophagogastroduodenoscopy in daily practice and to analyze the factors influencing its feasibility. Methods: To assess its feasibility, unsedated transnasal esophagogastroduodenoscopy was attempted in 1,000 consecutive patients. Two Olympus endoscopes were used : a 6.0-mm pediatric videoendoscope and a 5.3-mm diameter pediatric fiberscope. Patients with previous experience of peroral esophagogastroduodenoscopy were asked about their preference. Results: Transnasal esophagogastroduodenoscopy was feasible in 93.7% of the patients. In 62.5% of the cases of failure, endoscopy was immediately conducted passing the endoscope through the mouth. The only side-effects observed were epistaxis (1.6%), vaso-vagal reaction (0.3%) and nasal pain (1.5%). Biopsy specimens were taken in 43% of the patients. The causes for failure were refusal (20%), nasal pain (5%) and transnasal insertion failure (75%). Feasibility of transnasal esophagogastroduodenoscopy was related to both sex and endoscope diameter, but not to patient age (< or > 35) or endoscopist experience (junior or senior). Thus, female sex and large endoscope diameter (6.0-mm) were significant predictive factors of procedure failure. The failure rate of transnasal procedures was 3.5% in men, versus 12% in women, and 4.1% using the 5.3-mm diameter endoscope versus 17% using the 6.0-mm diameter endoscope (p<0.05). 90% of the patients with previous experience of peroral esophagogastroduodenoscopy did prefer transnasal esophagogastroduodenoscopy. Conclusions: Transnasal esophagogastroduodenoscopy is feasible in daily practice of diagnostic esophagogastroduodenoscopy, with rare side-effects, and prefered by patients. Feasibility of transnasal EGD is reduced in women and when using a 6.0-mm diameter endoscope.

Unsedated transnasal EGD: an alternative approach to conventional esophagogastroduodenoscopy for documenting Helicobacter pylori eradication

Background: The aim of this study was to assess the yield of antral biopsies performed via unsedated transnasal esophagogastroduodenoscopy, a technique that does not require conscious sedation with its concomitant costs and complications, for documentation of Helicobacter pylori eradication. Methods: Nineteen patients who were previously CLO test positive on conventional esophagogastroduodenoscopy and subsequently treated for H pylori infection were enrolled. The subjects had not received antibiotic therapy in the prior month and had no prior gastric surgery. By using a GIF-N30 fiberoptic endoscope and a tiny cup biopsy forceps (1.8 mm diameter), unsedated transnasal endoscopy was performed and antral biopsy specimens were taken for a CLO test, histologic analysis (Dieterle stain), and tissue culture. On the same day, the subjects underwent a carbon 13–labeled area urea breath test. All subjects completed a visual analog scale, rating the acceptability of the unsedated transnasal examination and the previous sedated conventional esophagogastroduodenoscopy. Results: There was no statistically significant difference between the results of the CLO tests (5/19 positive) versus the 13C-urea breath test (4/19 positive) (p = 0.96), the CLO tests versus histologic findings (5/19 positive) (p = 0.71), or the 13C-urea breath test versus histologic findings (p = 0.96). All tissue culture results were negative. The overall acceptability of unsedated transnasal esophagogastroduodenoscopy was similar to that of sedated conventional esophagogastroduodenoscopy. Conclusion: Unsedated transnasal esophagogastroduodenoscopy, a technique that eliminates the costs and complications associated with conscious sedation, is a feasible and accurate alternative to conventional esophagogastroduodenoscopy when documentation of H pylori eradication and confirmation of gastric ulcer healing are both indicated. (Gastrointest Endosc 1999;49:297-301.)

Struggling toward easier endoscopy

Struggling toward easier endoscopy

A comparative study of unsedated transnasal esophagogastroduodenoscopy and conventional EGD

Background: A significant portion of the cost and complications associated with conventional esophagogastroduodenoscopy (EGD) is attributed to conscious intravenous sedation, which usually results in loss of work on the day of the endoscopy. Earlier studies have described the feasibility and safety of unsedated transnasal EGD in normal volunteers. Methods: We compared the diagnostic yield and patient acceptability of this new technique performed first, with conventional EGD performed second in 24 outpatients. Results: The sensitivity of transnasal EGD was 89% and its specificity was 97%. Transnasal EGD was more acceptable and less stressful to the patients than conventional EGD ( p < 0.05). Oxygen saturation and blood pressure did not change during transnasal EGD. Conclusion: Transnasal EGD is feasible, safe, and well tolerated by patients. Specificity of transnasal EGD is similar to, but its sensitivity is lower than, conventional EGD. By eliminating the need for sedation-related work loss and postprocedural monitoring, transnasal EGD potentially is more cost-effective than conventional EGD. (Gastrointest Endosc 1996;44:422-4.)