Unsedated transnasal endoscopy: a Canadian experience in daily practice

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Patient Safety

Background:

• Esophagogastroduodenoscopy (EGD) is a common diagnostic tool for upper GI disorders.
• Conscious sedation during conventional EGD carries risks like hypoxia, increased costs, and patient inconvenience.
• Transnasal endoscopy offers potential advantages including no sedation, reduced monitoring, and lower expenses.

Purpose of the Study:

• To evaluate the feasibility and patient acceptability of unsedated transnasal EGD in routine clinical practice.
• To compare patient-reported outcomes between unsedated transnasal EGD and sedated per-oral EGD.

Main Methods:

• Patients chose between unsedated transnasal EGD or sedated per-oral EGD.
• Unsedated transnasal EGD was performed in an office setting by an experienced gastroenterologist using a small-caliber scope.
• Patient satisfaction was assessed via questionnaires rating discomfort (choking, sore throat, nasal, abdominal) and willingness for future procedures.

Main Results:

• 231 patients underwent transnasal EGD with 98% complete examinations.
• High patient acceptability (mean score 6.6) and low discomfort scores for choking (1.8), nasal (1.7), sore throat (0.8), and abdominal (1.1) were reported.
• Low complication rates (epistaxis 0.9%, sinusitis 0.4%) and high willingness for future procedures (88%); 62% preferred it over prior sedated EGD.

Conclusions:

• Unsedated transnasal EGD is well-tolerated, feasible, and safe for outpatient use with topical anesthesia.
• High patient satisfaction, low complication rates, and cost-effectiveness position it as an attractive alternative for upper GI disease screening.