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Transnasal vs transoral endoscopy under local anaesthetic

A study in September's issue of the Alimentary Pharmacology & Therapeutics compares acceptability, patient tolerance, cardiac stress and endoscopic views in transnasal and transoral endoscopy under local anaesthetic.

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Transnasal endoscopy with ultrathin endoscopes has been advocated as an attractive alternative, for diagnostic upper endoscopy.

Professor Plevris and colleagues from the United Kingdom assessed tolerability, acceptability and quality of transnasal endoscopy, in comparison with standard upper endoscopy under local anesthetic.

The research team prospectively recruited 157 patients mean age 57 years.

The Fujinon EG530N (5.9 mm) and EG530WR (9.4 mm) endoscopes were used.

The endoscopist and all patients completed detailed questionnaires regarding tolerability, acceptance and quality of endoscopy using standard visual analogue scales (VAS).

The research team recorded oxygen saturation, heart rate, and systolic blood pressure.

20% preferred the transnasal endoscopy
Alimentary Pharmacology & Therapeutics

Quality of biopsies was evaluated.

Analysis included 161 procedures with duodenal intubation achieved in all patients.

The team found that VAS scores for patient comfort were significantly better in the transnasal endoscopy group.

The researchers randomized 20 patients with previous experience of standard endoscopy to transnasal endoscopy, and 20% preferred the transnasal endoscopy.

Gagging was significantly less in the transnasal endoscopy group.

The research team found that cardiovascular stress was significantly less in the transnasal endoscopy group irrespective of the degree of gagging or comfort.

Transnasal endoscopy biopsies were smaller, but adequate for definitive diagnosis, similarly to standard endoscopy.

Professor Plevris' team concludes, "Transnasal endoscopy is superior to SOGD in terms of comfort and patient acceptance with significantly less cardiovascular stress."

"TNE can routinely be used as alternative to SOGD under local anesthetic, for diagnosis and should be preferentially offered in cardiorespiratory compromised patients."

Aliment Pharmacol Ther 2014: 40(5): 467–476
14 August 2014

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