Prospective randomized trial of transnasal versus peroral endoscopy using an ultrathin videoendoscope in unsedated patients

Murata, Atsuhiko; Akahoshi, Kazuya; Sumida, Yorinobu; Yamamoto, Hidehiko; Nakamura, Kazuhiko; Nawata, Hajime

doi:10.1111/j.1440-1746.2006.04730.x

Cited by 67 publications

(69 citation statements)

References 20 publications

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“…Previous studies have reported that the diagnostic accuracy of transnasal EGD is equivalent to that of standard transoral EGD for the detection of esophagogastric lesions, including gastric cancer [23][24][25][26][27][28][29][30] . 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] .…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…But both of the procedures have to change the tube from mouth to nose in the end, which aggravate the patient's discomfort and prolong the operation time. Transnasal gastroscopy with an outer diameter of 5.1-5.9 mm has been developed and used frequently for more than 10 years, which has been reported to be safer and more tolerable than traditional transoral gastroscopy (17,18). Compared with using traditional transoral gastroscope, nasoendoscopical placement method does not have to change the tube from mouth to nose in the end of the procedure, which shows advantage as a more successful technique for tube placement than others (19,20).…”

Section: Discussionmentioning

confidence: 99%

Application of bronchoscope for the placement of nasoenteric feeding tube in patients with esophagectomy: a novel technique

Cao

Zhang

et al. 2017

J. Thorac. Dis.

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Background: Currently the available techniques for the placement of nasoenteric feeding tube (NET), utilizing transnasal gastroscope are fast and tolerable, which is known as the most popular method. However, lots of hospitals don't have this endoscopic system. Bronchoscope, which is the basic respiratory endoscope, not only has the advantages of transnasal endoscopy, but also is popular in common hospitals. We used oxygen instillation as air supply plant of the bronchoscope, which broke its application limitation in digestive tract. The aim of this study is to evaluate the feasibility and availability of the method of placing NET with the bronchoscope in patients with esophagectomy.Methods: From January 2013 to January 2016, a total of 48 patients with esophagectomy who underwent NET placement with the bronchoscope were included in our study. Information concerning age, gender, as well as background disease of the patients was collected. The success rate, procedure duration, and complications were recorded for each patient. Results:The technique success rate reached 100%, procedure time ranged from 150 to 750 s, with an average time of 257 s. All patients tolerated well under local anesthesia, no complication of epistaxis or perforation occurred. Conclusions:The new technique of placing NET with the bronchoscope is fast, safe, effective, and well tolerated for patients with esophagectomy.

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“…Unsedated transoral EGD is well known to increase BP and PR, with an increased cardiopulmonary work load [2,[4][5][6] . Recently, small-caliber endoscopes have been developed and used for EGD with the transnasal route.…”

Section: Discussionmentioning

confidence: 99%

“…Small-caliber endoscopy of the upper gastrointestinal tract was developed and for transnasal esophagogastro duodenoscopy (EGD) and has been used frequently in the past decade [1][2][3][4] . Transnasal small-caliber EGD has improved the safety of the endoscopic examination, and has fewer adverse effects on cardiopulmonary function [5][6][7][8][9][10] and autonomic nerve function [11] , compared with transoral conventional EGD.…”

Section: Introductionmentioning

confidence: 99%

Unsedated transnasal small-caliber esophagogastroduodenoscopy in elderly and bedridden patients

Yuki¹,

Amano²,

Komazawa³

et al. 2009

WJG

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AIM:To evaluate the safety of unsedated transnasal small-caliber esophagogastroduodenoscopy (EGD) for elderly and critically ill bedridden patients. METHODS:One prospective randomized comparative study and one crossover comparative study between transnasal small-caliber EGD and transoral conventional EGD was done (Study 1). For the comparative study, we enrolled 240 elderly patients aged > 65 years old. For the crossover analysis, we enrolled 30 bedridden patients with percutaneous endoscopic gastrostomy (PEG) (Study 2). We evaluated cardiopulmonary effects by measuring arterial oxygen saturation (SpO2) and calculating the rate-pressure product (RPP) (pulse rate × systolic blood pressure/100) at baseline, 2 and 5 min after endoscopic intubation in Study 1. To assess the risk for endoscopy-related aspiration pneumonia during EGD, we also measured blood leukocyte counts and serum C-reactive protein (CRP) levels before and 3 d after EGD in Study 2. RESULTS:In Study 1, we observed significant decreases in SpO2 during conventional transoral EGD, but not during transnasal small-caliber EGD (0.24% vs -0.24% after 2 min, and 0.18% vs -0.29% after 5 min, P = 0.034, P = 0.044). Significant differences of the RPP were not found between conventional transoral and transnasal small-caliber EGD. In Study 2, crossover analysis showed statistically significant increases of the RPP at 2 min after intubation and the end of endoscopy (26.8 and 34.6 vs 3.1 and 15.2, P = 0.044, P = 0.046), and decreases of SpO2 (-0.8% vs -0.1%, P = 0.042) during EGD with transoral conventional in comparison with transnasal small-caliber endoscopy. Thus, for bedridden patients with PEG feeding, who were examined in the supine position, transoral conventional EGD more severely suppressed cardiopulmonary function than transnasal small-caliber EGD. There were also significant increases in the markers of inflammation, blood leukocyte counts and serum CRP values, in bedridden patients after transoral conventional EGD, but not after transnasal small-caliber EGD performed with the patient in the supine position. Leukocyte count increased from 6053 ± 1975/L to 6900 ± 3392/L (P = 0.0008) and CRP values increased from 0.93 ± 0.24 to 2.49 ± 0.91 mg/dL (P = 0.0005) at 3 d after transoral conventional EGD. Aspiration pneumonia, possibly caused by the endoscopic examination, was found subsequently in two of 30 patients after transoral conventional EGD. CONCLUSION:Transnasal small-caliber EGD is a safer method than transoral conventional EGD in critically ill, bedridden patients who are undergoing PEG feeding.

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Prospective randomized trial of transnasal versus peroral endoscopy using an ultrathin videoendoscope in unsedated patients

Abstract: For unsedated endoscopy using an ultrathin videoendoscope, transnasal EGD is well tolerated and considerably reduces patient discomfort compared with peroral EGD.

Cited by 67 publications

References 20 publications

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

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

Application of bronchoscope for the placement of nasoenteric feeding tube in patients with esophagectomy: a novel technique

Unsedated transnasal small-caliber esophagogastroduodenoscopy in elderly and bedridden patients

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