Unsedated transnasal endoscopy experience at a tertiary referral center in India

Unsedated transnasal endoscopy (uTNE) was developed in the 1990s but has not gained widespread use. We present our experience with uTNE at a tertiary referral center in India.

A retrospective analysis was conducted with prospectively collected data of patients who underwent uTNE for predominantly diagnostic EGD at our center between January 2014 and September 2017. Patients received 2% lidocaine spray over the back of the throat, xylometazoline, and 10% lidocaine sprays in the nostril 10 minutes before uTNE. Successful completion of TNE without the need for sedation, conversion to peroral EGD (PO-EGD), epistaxis, and tolerance of the procedure compared with prior PO-EGD were the outcomes of interest. Unsedated PO-EGD (uPO-EGD) is the standard of care at our center. Logistic regression was used for analysis.

Successful completion of uTNE (414/440 patients) was significantly associated with male sex (odds ratio [OR], 2.67; 95% confidence interval [CI], 1.16-6.14). Conversion to PO-EGD (4.32%) was significantly associated with age (OR, .96; 95% CI, .94-.99), year of endoscopy (OR, .44; 95% CI, .24-.82), and male sex (OR, .33; 95% CI, .12-.89) in multivariable analysis. Rate of epistaxis was 6.76%, and 93.09% of patients (229/246) tolerated uTNE better than prior PO-EGD. There were no life-threatening or major adverse events requiring prolonged hospitalization.

uTNE should be offered as an alternative to uPO-EGD for diagnostic EGD. Studies comparing tolerance and adverse events of uTNE with those of sedated PO-EGD are required given the costs and potential adverse events associated with sedation.