Adverse events are lower in unsedated transnasal esophagoscopy versus sedated esophagogastroduodenoscopy

Unsedated transnasal esophagoscopy (TNE) is an innovative and minimally invasive technique becoming more commonplace in pediatric gastroenterology. The advantages include no anesthesia, decreased cost, and less time away from work and school. There is no published data evaluating postprocedure adverse events (AE) with TNE. The aim of this study was to evaluate postprocedure AE associated with TNE compared to sedated esophagogastroduodenoscopy (EGD).

AE data were prospectively collected for patients ages 5-22 years who underwent endoscopy at a tertiary children's hospital between January 2015 and June 2022. Demographic data and procedural factors were collected, and AE were categorized using a standardized scoring system.

A total of 10,023 diagnostic EGD's on 7786 patients and 927 TNE's on 492 patients were performed. The total number of AE (Grade I-IV) observed were 196 after EGD and 1 after TNE. The total AE rate for EGD's was significantly higher than for TNE's (1.96% vs. 0.11%, p < 0.0001). The clinically significant AE (Grade II or higher) for EGD's was higher than TNE's (0.67% vs. 0%, p = 0.006). In controlling for eosinophilic esophagitis (EoE) as the indication, the total AE and the clinically significant AE for EGD's were higher than TNE's ([1.87% vs. 0.12% p < 0.001], [0.75% vs. 0% p = 0.01]).

The postprocedure AE rate for TNE was lower than EGD both for overall and clinically significant AE. This suggests TNE is a safer approach for monitoring esophageal pathology than sedated EGD for patients who can undergo TNE.