Unsedated transnasal esophagoscopy for monitoring therapy in pediatric eosinophilic esophagitis

Abstract

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.

Diagnosis and Treatment of Eosinophilic Esophagitis

“…In a study of 22 children (8-17 years old) with EoE, most patients and parents favored transnasal endoscopy over standard endoscopy and would repeat the procedure. 52 Biopsy specimens were adequate without difference in surface area compared with standard endoscopy and biopsy. Further studies are needed to determine if this is generally applicable to adult populations and young children.…”

Diagnosis and treatment of eosinophilic esophagitis

“…31 Unsedated transnasal endoscopy has been used in children and adults to assess esophageal mucosal inflammation through biopsy. 32,33 More recently, a tethered confocal microscopy capsule has been piloted in adults with EoE, with preliminary data suggesting that comprehensive cellular data can be gathered for assessment of tissue inflammation. 34 Each of these modalities show promise in being able to assess inflammation without the use of standard endoscopy.…”

EoE disease monitoring

“…A recent advance in endoscopic monitoring of EoE has been transnasal esophagoscopy or endoscopy. 29 This is an endoscopy that is done in an awake patient that has been shown to generate biopsy samples that are not statistically different from biopsies performed during standard endoscopy, therefore creating a way to monitor EoE activity without sedation and anesthesia. Virtual reality video goggles have been used to aid children in undergoing this procedure.…”