Current Status and Evaluation of Transnasal Esophagogastroduodenoscopy

Tatsumi, Yoshihide; Harada, Akira; Matsumoto, Takahiro; Tani, Tohru; Nishida, Hiroshi

doi:10.1111/j.1443-1661.2009.00891.x

Cited by 34 publications

(38 citation statements)

References 32 publications

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“…The only complication registered in this study (epistaxis, 4 %) was also noted in previous publications, with similar incidence rates: ranging from 0 % to 5 % 31 32 . In all cases, epistaxis was mild and self-limited, with resolution within a few minutes after the procedure and without requiring any intervention.…”

Section: Resultssupporting

confidence: 90%

Feasibility of transnasal endoscopy in screening for esophageal and gastric varices in patients with chronic liver disease

et al. 2017

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Background and study aims Screening for esophageal and gastric varices is indicated for patients with portal hypertension or cirrhosis. Typically, conventional endoscopy is used; however, the need for sedation increases the costs and risks, especially in cirrhotic patients. Use of transnasal endoscopy with an ultrathin endoscope enables study of the upper gastrointestinal tract without the need for sedation. The objective of this study is to evaluate the feasibility of transnasal endoscopy in screening for esophageal and gastric varices in patients with chronic liver disease. Patients and methods This was a prospective study in which transnasal endoscopy was carried out in patients with cirrhosis or portal hypertension who had indications for screening of esophageal and gastric varices. The following variables were evaluated: demographical data, duration of procedure, patient tolerance and acceptance, adverse events (AEs), endoscopic findings and interobserver agreement related to portal hypertension alterations ( kappa index). Results A total of 50 patients entered the study. The most common cause of liver disease was chronic viral hepatitis (66 %). Among the cirrhotic patients, most of the patients were Child-Pugh A (74 %). In 5 patients (10 %), nasal intubation was not possible. Two patients (4 %) experienced minor epistaxis. Tolerance was excellent or good in 92 % according with a visual analogic scale. In 16 patients (32 %), esophageal varices were detected and in 2 patients (4 %) gastric varices were detected. The mean duration of the procedure was 7 minutes. Conclusions Transnasal endoscopy is feasible, effective and well tolerated for screening of esophageal and gastric varices in patients with chronic liver disease. It can be performed in outpatient clinics safely and without the use of sedation.

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Section: Resultssupporting

confidence: 90%

Feasibility of transnasal endoscopy in screening for esophageal and gastric varices in patients with chronic liver disease

et al. 2017

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“…11–17 A number of studies have described the advantages, limitations, and challenges of TNE use, and in 2010, the American Society for Gastrointestinal Endoscopy developed a guideline for the use of TNE in adults. 24–27 This guideline increased attention to cost containment, and the recent upswing in interest in esophageal diseases led to renewed interest in this technique. 25,28–30 A recent study also demonstrated the utility of TNE in adults with Barrett’s esophagus.…”

Section: Discussionmentioning

confidence: 99%

“…25,28–30 A recent study also demonstrated the utility of TNE in adults with Barrett’s esophagus. 27,28,31 To date, only 1 study evaluated unsedated transoral endoscopy in children and concluded that it improved time and safety in assessing 21 children for evaluation of abdominal pain, dyspepsia, and dysphagia. 32 …”

Section: Discussionmentioning

confidence: 99%

Unsedated transnasal esophagoscopy for monitoring therapy in pediatric eosinophilic esophagitis

Friedlander

DeBoer

Soden

et al. 2016

Gastrointestinal Endoscopy

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Background and Aims Unsedated transnasal endoscopy (TNE) is safer and less costly than sedated EGD. The aim of this study was to evaluate the performance of TNE with biopsies in monitoring the esophageal mucosa of pediatric patients with eosinophilic esophagitis. Methods Patients between 8 and 17 years of age with eosinophilic esophagitis and their parents were enrolled. Unsedated TNE was performed. A 2.8-mm (1.2-mm channel) or a 4-mm flexible bronchoscope (2-mm channel) was used, and esophageal biopsy specimens were obtained. Biopsy specimen analysis, duration, adverse events, and billing charges of TNE were assessed. Immediately after TNE and a minimum of 2 weeks later, a modified Group Health Association of America 9 survey and a preference questionnaire were completed, respectively. Results Twenty-one of 22 enrolled patients underwent TNE. TNE was performed with no serious adverse events. Histopathological analysis revealed 0 eosinophils per high-power field (n = 12), fewer than 15 eosinophils per high-power field (n = 4), and more than 15 eosinophils per high-power field (n = 5). The total epithelial surface area of mucosal biopsy samples from either TNE Forceps (1.2 mm or 2 mm biopsy channel forceps) compared with those obtained during the subject’s previous EGD by using standard endoscopic forceps was not statistically different (P = .308 [1.2 mm]/P = .492 [2 mm]). All parents and 76.2% of subjects would undergo the TNE again. TNE was preferred over EGD by 85.7% of parents and 52.4% of subjects. The modified Group Health Association of America 9 survey revealed a high degree of satisfaction (average, 43.19 ± 2.6; maximum score, 45). Charges associated with TNE were 60.1% lower than for previous EGDs. Conclusions Unsedated TNE is an effective, lower-cost procedure for monitoring the esophageal mucosa of children with eosinophilic esophagitis.

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“…However, despite recent advances in endoscopic technologies, small-diameter endoscopes used for transnasal EGD still show disadvantages when compared to standard endoscopes, due to lower luminous intensity, lower resolution of endoscopic images, a narrow field of view, low maneuverability and low biopsy performance, all of which are attributable to the small diameter of the endoscope [31] . Yoshida et al [30] found no significant differences in detection rates of early gastric cancer and adenoma between transnasal and standard transoral EGD, but also noted that gastric cancers may be overlooked by transnasal EGD when performed by less-experienced endoscopists.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the screening performance of transnasal EGD might have been overestimated, although it still remains suboptimal compared with that of standard transoral EGD. Since tolerability, acceptability and safety of transnasal EGD with a small-diameter endoscope are better than standard transoral EGD, transnasal EGD has been increasingly used for gastric cancer screening [30][31][32] . However, the present results indicate that the screening performance of transnasal EGD remains suboptimal, even in subjects with extensive CAG, which represents a key route of stomach carcinogenesis in Japan.…”

mentioning

confidence: 99%

Transnasal and standard transoral endoscopies in the screening of gastric mucosal neoplasias

Nakata¹,

Enomoto²,

Maekita³

et al. 2011

WJGE

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AIM:To compare the diagnostic performances of transnasal and standard transoral esophagogastroduodenoscopy (EGD) in gastric cancer screening of asymptomatic healthy subjects. METHODS:Between January 2006 and March 2010, a total of 3324 subjects underwent examination of the upper gastrointestinal tract by EGD for cancer screening, with 1382 subjects (41.6%) screened by transnasal EGD and the remaining 1942 subjects (58.4%) by standard transoral EGD. Clinical profiles of the screened subjects, detection rates of gastric neoplasia and histopathology of the detected neoplasias were compared between groups according to the stage of Helicobacter pylori (H. pylori )-related chronic gastritis. RESULTS:Clinical profiles of subjects did not differ significantly between the two EGD groups, except that there were significantly more men in the transnasal EGD group. During the study period, 55 cases of gastric mucosal neoplasias were detected. Of these, 23 cases were detected by transnasal EGD and 32 cases by standard transoral EGD. The detection rate for gastric mucosal neoplasia in the transnasal EGD group was thus 1.66%, compared to 1.65% in the standard transoral EGD group, with no significant difference between the two groups. Detection rates using the two endoscopies were likewise comparable, regardless of H. pylori infection. However, detection rates when screening subjects without extensive chronic atrophic gastritis (CAG) were significantly higher with standard transoral EGD (0.70%) than with transnasal EGD (0.12%, P < 0.05). In particular, standard transoral EGD was far better for detecting neoplasia in subjects with H. pylori -related non-atrophic gastritis, with a detection rate of 3.11% compared to 0.53% using transnasal EGD (P < 0.05). In the screening of subjects with extensive CAG, no significant differences in detection of neoplasia were evident between the two endoscopies, although the mean size of detected cancers was significantly smaller and the percentage of early cancers was significantly higher with standard transoral EGD.

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Current Status and Evaluation of Transnasal Esophagogastroduodenoscopy

Cited by 34 publications

References 32 publications

Feasibility of transnasal endoscopy in screening for esophageal and gastric varices in patients with chronic liver disease

Feasibility of transnasal endoscopy in screening for esophageal and gastric varices in patients with chronic liver disease

Unsedated transnasal esophagoscopy for monitoring therapy in pediatric eosinophilic esophagitis

Transnasal and standard transoral endoscopies in the screening of gastric mucosal neoplasias

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