Post written by Ravi Teja Pasam, MBBS, MPH, from Wentworth-Douglass Hospital, Dover, New Hampshire, USA.

Our study focuses on the unsedated transnasal endoscopy (uTNE) experience at a tertiary care center in India. Completion rate, tolerance, and adverse events of uTNE were studied. Tolerance of uTNE was compared with that of prior peroral EGD (PO-EGD) experience. PO-EGD is usually an unsedated procedure at our center.

Around for decades, uTNE has potential advantages, but it is still not widely practiced. Compared with unsedated PO-EGD, it minimizes discomfort by avoiding contact with areas in the oral cavity and pharynx that cause gagging.

Data on uTNE from India, where unsedated PO-EGD is the usual practice, are scarce. Although not the focus of our study, uTNE has the potential benefits of avoiding the direct and indirect costs of sedation such as loss of work and arrangement for a ride home after sedated PO-EGD. Hence, we hoped to shine light on uTNE, so that it can be studied in comparison with sedated PO-EGD. This is especially important, as demand for sedated endoscopic procedures continues to rise.

In this study conducted from January 2014 to September 2017, uTNE was performed mostly for diagnostic purposes after spraying a local anesthetic in the nares and back of the throat and a nasal decongestant in the nares to minimize discomfort and epistaxis. Our study demonstrated that uTNE has a 94% (414/440 patients) completion rate. Seven patients needed sedation in addition to the local anesthetic spray to complete transnasal endoscopy.

The procedure was converted to PO-EGD in 19 patients. Younger and female patients had higher odds of conversion to PO-EGD in multivariable analysis. The odds of conversion decreased with every 1-year progression in the study period, possibly indicating increasing confidence of endoscopists to accomplish uTNE. Among the 246 patients who had prior PO-EGD experience, 93% reported better tolerance with uTNE, and 6.5% observed comparable experience.

Although nasal mucosal spotting was noted in 21 patients, frank epistaxis was identified in 7 patients.  The only adverse event other than epistaxis was an impacted endoscope in the nasal passage that an otorhinolaryngologist removed with the patient under total intravenous anesthesia.

Compared with unsedated PO-EGD, uTNE has an excellent completion rate, better tolerance, and minimal adverse events. Future studies should focus on comparing uTNE with sedated PO-EGD, specifically in terms of tolerance, adverse events, diagnostic capability, image quality, and cost-effectiveness.

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