Unsedated Transnasal Endoscopy: A Safe, Well-Tolerated and Accurate Alternative to Standard Diagnostic Peroral Endoscopy

Rebecca K Grant, William M Brindle, Alexander R Robertson, Rahul Kalla, John N Plevris, Rebecca K Grant, William M Brindle, Alexander R Robertson, Rahul Kalla, John N Plevris

Abstract

Diagnostic unsedated transnasal endoscopy (uTNE) has been proven to be a safe and well-tolerated procedure. Although its utilization in the United Kingdom (UK) is increasing, it is currently available in only a few centers. Through consideration of recent studies, we aimed to perform an updated review of the technological advances in uTNE, consider their impact on diagnostic accuracy, and to determine the role of uTNE in the COVID-19 era. Current literature has shown that the diagnostic accuracy of uTNE for identification of esophageal pathology is equivalent to conventional esophagogastroduodenoscopy (cEGD). Concerns regarding suction and biopsy size have been addressed by the introduction of TNE scopes with working channels of 2.4 mm. Advances in imaging have improved detection of early gastric cancers. The procedure is associated with less cardiac stress and reduced aerosol production; when combined with no need for sedation and improved rates of patient turnover, uTNE is an efficient and safe alternative to cEGD in the COVID-19 era. We conclude that advances in technology have improved the diagnostic accuracy of uTNE to the point where it could be considered the first line diagnostic endoscopic investigation in the majority of patients. It could also play a central role in the recovery of diagnostic endoscopic services during the COVID-19 pandemic.

Keywords: Barrett’s esophagus; Eosinophilic esophagitis; Esophageal varices; Gastric cancer; Trans-nasal endoscopy.

Conflict of interest statement

JNP has received research and educational support from Aquilant Limited. RKG, WMB, ARR and RK have no conflicts of interest to declare.

© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Figures

Fig. 1
Fig. 1
Peroral versus transnasal routes of insertion. a Peroral route with trigger points for gag reflex. Highlighted (a) palate; (b) uvula; (c) fauces; (d) base of tongue; (e) posterior pharyngeal wall. b Transnasal route. Illustrations courtesy of Mr Stephen Liddell, Creative82
Fig. 2
Fig. 2
Visualization of the epiglottis
Fig. 3
Fig. 3
Comparison of tip and biopsy channel diameter of a standard endoscope versus transnasal endoscopes. Illustration courtesy of Dr S Inglis, Department of Medical Physics, The Royal Infirmary of Edinburgh
Fig. 4
Fig. 4
Advances in TNE field of view. 120° (left image) versus 140° field of view (right image) of esophagogastric junction captured by two different TNE endoscopes using the same Endoscopy Video Processor

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