Comparision between per-oral and ultrathin transnasal endoscopy in unsedated patients

This is a prospective study to evaluate the tolerance and acceptability of patients for diagnostic ultrathin transnasal esophagogastroduodenoscopy compared with the standard peroral route.

Both types of endoscopic procedures were explained to the patients. Sixty patients were included in this study and subsequently, 30 unsedated patients in each group underwent upper gastrointestinal endoscopy. An evaluation and questionnaire form both the endoscopist and the patient was recorded. Out of the 30 patients who had transnasal endoscopy, 15 had previous peroral endoscopy. Oximetry was recorded during the procedure.

All patients in both groups tolerated the procedure well and it was successfully completed. In the transnasal group, three patients had mild epistaxis. Desaturation in the transnasal group was the same as compared to the peroral group. From the 30 patients of transnasal group, 21 were willing to repeat the procedure if required and eight patients were willing to repeat the procedure reluctantly. Only one patient expressed preference for the peroral route. The endoscopist's observation revealed that scope insertion in both groups was equally tolerated but lens washing and suction was not optimal in the transnasal approach.

Both groups showed good tolerability, but the tranasal approach was found to be more acceptable to the patient. In the tranasal group, the patients found the procedure less distressing and were subsequently more willing for a repeat procedure. Therefore we believe that the tranasnal approach to esophagogastroduodenoscopy in diagnostic and follow up procedures will rapidly acquire increasing popularity.