Randomised clinical study: comparison of acceptability, patient tolerance, cardiac stress and endoscopic views in transnasal and transoral endoscopy under local anaesthetic

Alexandridis, Efstratios; Inglis, Scott; McAvoy, Norma C.; Falconer, E.; Graham, Catriona; Hayes, Peter; Plevris, John

doi:10.1111/apt.12866

Cited by 27 publications

(29 citation statements)

References 41 publications

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“…Stroppa et al 21 conducted a comparative study in which patients were submitted to 2 exams on different days, TNE (without sedation) or EGD (under sedation). The authors reported that 87 % of their patients also preferred TNE, similar to data from other studies 22 23 . …”

Section: Resultssupporting

confidence: 84%

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: 84%

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

et al. 2017

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“…The assessment of cardiac function and oxygen saturation are both objective methods of evaluating safety and tolerability of endoscopic procedures. Previous studies have shown that TNE causes fewer adverse effects on cardiovascular function than transoral OGD 36 40 41. It is also less stressful to the cardiovascular system with reduced elevation of systolic blood pressure and less sympathetic stimulation than the oral procedure 41.…”

Section: Patient Tolerability Side Effects and Safetymentioning

confidence: 99%

Transnasal endoscopy: no gagging no panic!

Parker

Alexandridis

Plevris

et al. 2015

Frontline Gastroenterol

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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 GORDassociated 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.

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“…Previous studies have attempted to quantify hemodynamic shifts during TNFE in both laryngeal and esophageal procedures . In the field of otolaryngology, two specific studies have laid the groundwork for this investigation …”

Section: Introductionmentioning

confidence: 99%

Timing of hemodynamic changes during transnasal endoscopic surgery

2015

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Randomised clinical study: comparison of acceptability, patient tolerance, cardiac stress and endoscopic views in transnasal and transoral endoscopy under local anaesthetic

Abstract: SUMMARY BackgroundTransnasal endoscopy (TNE) with ultrathin endoscopes has been advocated as an attractive alternative, for diagnostic upper endoscopy.

Cited by 27 publications

References 41 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

Transnasal endoscopy: no gagging no panic!

Timing of hemodynamic changes during transnasal endoscopic surgery

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