Unsedated small caliber esophagogastroduodenoscopy: can we trust this technique?

Small caliber endoscopes are one of the best examples of fantastic technological advancements in gastrointestinal endoscopy. First designed for pediatric patients in the 1970s, current small caliber videoendoscopes were used for unsedated transnasal gastrointestinal endoscopy after 1994. Nowadays, unsedated endoscopy can be successfully done using small caliber endoscopes via transoral or transnasal route in nearly 90% of cases. Several large studies have shown that small caliber endoscopy is feasible, safe and well-tolerated. These devices can decrease the potential risks of upper gastrointestinal endoscopy by eliminating the need for sedation since these ultrathin endoscopes induce much less gag reflex or choking sensation in patients. Moreover, gastrointestinal endoscopy with small caliber endoscopes results in less sympathetic system activation as well as less oxygen desaturation compared to standard endoscopy, especially in aged, severely ill, bedridden patients. Nevertheless, there is no overall consensus on its cost effectiveness. Though indications are similar with standard endoscopy, small caliber endoscopy can be preferred in patients with gastrointestinal stenosis. Less common indications include transnasal endoscopic retrograde cholangiography and postpyloric feeding tube insertion. The esophagogastroduodenoscopy procedure with small caliber endoscopes is easy to perform, and there is generally no need for further training for this technique. However, the additional cost of equipment and some medicolegal and technical issues have resulted in the unpopularity of small caliber endoscopy in most countries other than France and Japan. However, sharing information about this technique and stressing its potential advantages can help in its widespread use in various countries including Turkey. We believe that routine use of small caliber endoscopes during daily gastrointestinal endoscopy practice is not far away in many countries.