Left lateral decubitus position during sedation-free transnasal endoscopy: A pilot study

Area of Science:

• Pediatric Gastroenterology
• Endoscopic Procedures
• Patient Safety

Background:

• Sedation-free transnasal endoscopy (TNE) is a common pediatric procedure for upper gastrointestinal evaluation.
• Current TNE techniques in children typically adapt adult standards, often using an upright seated position.
• The left lateral decubitus (LLD) position is proposed as a potentially safer and more effective alternative for TNE.

Purpose of the Study:

• To explore the feasibility and tolerance of performing sedation-free TNE in pediatric patients utilizing the LLD position.
• To compare the LLD position with the traditional upright seated position for pediatric TNE.

Main Methods:

• Retrospective review of 13 pediatric patients undergoing sedation-free TNE in the LLD position.
• Data collected included procedure time, patient tolerance (TNEase score), and adverse events.
• Patient demographics were also analyzed.

Main Results:

• All 13 TNE procedures in the LLD position were successfully completed.
• The mean procedure time was 5.1 minutes.
• All patients reported good tolerance (TNEase score ≤ 2), with 77% scoring 1.
• Two patients who experienced syncope in the upright position tolerated LLD TNE without adverse events.

Conclusions:

• The left lateral decubitus position is a feasible and well-tolerated approach for sedation-free TNE in children.
• Further prospective studies are warranted to confirm the benefits of the LLD position over the upright position, especially for children with orthostatic intolerance.