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. 2016 Oct;7(4):246-256.
doi: 10.1136/flgastro-2015-100589. Epub 2015 Jul 2.

Transnasal endoscopy: no gagging no panic!

Clare Parker  1 , Estratios Alexandridis  2 , John Plevris  3 , James O'Hara  4 , Simon Panter  5
Affiliations

Transnasal endoscopy: no gagging no panic!

Clare Parker et al. Frontline Gastroenterol. 2016 Oct.

Abstract

Background: Transnasal endoscopy (TNE) is performed with an ultrathin scope via the nasal passages and is increasingly used. This review covers the technical characteristics, tolerability, safety and acceptability of TNE and also diagnostic accuracy, use as a screening tool and therapeutic applications. It includes practical advice from an ear, nose, throat (ENT) specialist to optimise TNE practice, identify ENT pathology and manage complications.

Methods: A Medline search was performed using the terms "transnasal", "ultrathin", "small calibre", "endoscopy", "EGD" to identify relevant literature.

Results: There is increasing evidence that TNE is better tolerated than standard endoscopy as measured using visual analogue scales, and the main area of discomfort is nasal during insertion of the TN endoscope, which seems remediable with adequate topical anaesthesia. The diagnostic yield has been found to be similar for detection of Barrett's oesophagus, gastric cancer and GORD-associated diseases. There are some potential issues regarding the accuracy of TNE in detecting small early gastric malignant lesions, especially those in the proximal stomach. TNE is feasible and safe in a primary care population and is ideal for screening for upper gastrointestinal pathology. It has an advantage as a diagnostic tool in the elderly and those with multiple comorbidities due to fewer adverse effects on the cardiovascular system. It has significant advantages for therapeutic procedures, especially negotiating upper oesophageal strictures and insertion of nasoenteric feeding tubes.

Conclusions: TNE is well tolerated and a valuable diagnostic tool. Further evidence is required to establish its accuracy for the diagnosis of early and small gastric malignancies. There is an emerging role for TNE in therapeutic endoscopy, which needs further study.

Keywords: BARRETT'S OESOPHAGUS; DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY; ENDOSCOPY; GASTRIC CANCER; OESOPHAGEAL VARICES.

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Figures

Figure 1
Figure 1
Differences in method of insertion between standard and transnasal approach (diagram courtesy of Dr S Inglis).
Figure 2
Figure 2
Rigid endoscope showing benign polyps within the right nasal cavity.
Figure 3
Figure 3
Right-sided glottic squamous carcinoma (viewed under general anaesthesia with rigid laryngoscope).
Figure 4
Figure 4
Left-sided glottic granuloma (viewed under general anaesthesia with rigid laryngoscope).
Figure 5
Figure 5
View of oesophagogastric junction for transnasal endoscopy.
Figure 6
Figure 6
View of oesophagogastric junction for standard endoscopy.
See this image and copyright information in PMC

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