Endoscopic meatus scoring scale versus sniff test to predict insertability before transnasal endoscopy: A...

Area of Science:

• Gastroenterology
• Endoscopy
• Medical Devices

Background:

• The sniff test is a common, yet subjective, method for selecting nasal insertion sites for unsedated transnasal esophago-gastro-duodenoscopy (UT-EGD).
• Objective methods are needed to optimize nasal meatus selection for improved patient tolerance and reduced adverse events during UT-EGD.

Purpose of the Study:

• To evaluate the efficacy of a novel endoscopic meatus scoring scale, derived from anterior meatuscopy, in selecting the optimal nasal insertion tract for UT-EGD.
• To compare patient tolerance and adverse events between the meatuscopy-guided approach and the conventional sniff test.

Main Methods:

• A prospective randomized controlled trial was conducted involving 310 patients undergoing UT-EGD.
• Patients were randomized to either the meatuscopy group or the conventional sniff test group for nasal insertion site selection.
• Patient tolerance, pain scores, and adverse events were systematically assessed.

Main Results:

• The meatuscopy group reported significantly lower pain scores during nasal anesthesia, insertion/exsertion, and overall UT-EGD.
• Patients in the meatuscopy group experienced significantly less epistaxis, improved visual capacity post-anesthesia, and shorter procedure times.
• Higher patient satisfaction and a greater likelihood to repeat the procedure were observed in the meatuscopy group, with fewer instances of nasal discharge and post-procedural complications.

Conclusions:

• Anterior meatuscopy provides an objective method for selecting the optimal nasal insertion tract for UT-EGD.
• This endoscopic approach significantly reduces nasal pain, epistaxis, and post-procedural side effects compared to the sniff test.
• Meatuscopy enhances patient tolerance and outcomes for nasal anesthesia and UT-EGD procedures.