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

Sedation-free transnasal endoscopy (TNE) is a safe, feasible, and well tolerated procedure performed in children to evaluate the upper gastrointestinal tract. The procedural technique of TNE in children is adopted from procedural standards in adults, typically using the upright seated position. The left lateral decubitus (LLD) position may be preferred for optimal safety and visualization during TNE. This pilot study explored the feasibility and tolerance of TNE in pediatric patients using the LLD position.

This was a retrospective review of 13 children who underwent sedation-free TNE in the LLD position from October 2024 to February 2025 in an outpatient gastroenterology procedure suite. Procedure time, patient tolerance (TNEase score), adverse events, and patient demographics were collected and analyzed.

A total of 13 TNE procedures were successfully completed in the LLD position. The mean (standard deviation (SD)) age of the cohort was 12 years (2.7); 38% were female. The mean (SD) procedural time for esophagoscopy was 5.1 min (1.6). All patients had TNEase score of 2 or lower. Ten (77%) of patients had a TNEase score of 1. Two patients with history of anxiety and orthostasis experienced syncope in the upright seated position but subsequently completed the TNE in the LLD position without adverse events.

LLD position for sedation-free TNE is feasible and well tolerated in children. Findings should prompt further, prospective investigations of the benefits of LLD versus upright seated position, particularly in children with orthostatic intolerance.