Krefeld CONTRA Study: Conventional Peroral Esophago-Gastro-Duodenoscopy (EGD) vs. Transnasal EGD – a Prospective and Randomised Study with Independent Evaluation of Conscious Sedation, Endoscope Diameter, and Access Path

Abstract

Unsedated transnasal EGD may replace diagnostic peroral EGD, reduces costs with acceptable patient discomfort and has advantagous acceptability of the endoscopic staff.

Is the Transnasal Access for Esophagogastroduodenoscopy in Routine Use Equal to the Transoral Route? A Prospective, Randomized Trial

“…In the intra-individual control group 3 (TON-EGD), 4 out of 5 patients rated a TN-EGD to be more acceptable than the previously experienced TO-EGD and would ask for a TN-EGD in the future. Similar results were found before [2,3,11,13,14,18]. Thin endoscopes have been used also for TO-EGD and tolerance was found to be the same as for TN-EGD [15,19].…”

“…Thus, professional endoscopic societies have published guidelines [26 -28] that require a qualified assistant during a procedure under sedation, as well as monitoring of vital signs for 1 -2 hours afterwards. Resources in form of equipment, manpower and a recovery room as well as the inability for legal decisions and taking part in traffic for 12 -24 hours, cause sedation to crave resources and produce higher costs [7,13].…”

Office-based procedures for diagnosis and treatment of esophageal pathology

“…Inspection of the mucosa is performed by pulling the endoscope slowly upward in a circumferential manner. For inspection of the esophagus, air is blown through the working channel to open the esophagus . The gastrointestinal junction is difficult to inspect and requires more time.…”

“…The authors concluded that after 1 year, the initial costs of purchasing the esophagoscope were fully met and from there on, £230 (82%) per patient is saved. Frieling et al found pharmaceutical cost reduction of [euro]18.489 per year for unsedated TN‐EGD compared to sedated TN‐EGD. Potential cost savings could come from reduction in radiology (barium swallow ± £150), follow‐up (±£80) and esophagoscopy in general anesthesia (±£450) .…”

“…For inspection of the esophagus, air is blown through the working channel to open the esophagus. 4,6,7,[15][16][17][18]20,21,24,25,29,[31][32][33][37][38][39]42,43,[47][48][49][50]52,57,[63][64][65][66] The gastrointestinal junction is difficult to inspect and requires more time. The caudal portion of the gastrointestinal junction can be visualized by passing the endoscope in the gastric cardia and by performing a retroflexion of the tip of the endoscope up to 210 8, although not all endoscopes possess this feature.…”