Prospective evaluation of transnasal esophagogastroduodenoscopy: feasibility and study on performance and tolerance

Background: With a pediatric endoscope, esophagogastroduodenoscopy (EGD) ca n be performed via a nasal route in adults. To evaluate this new procedure, we conducted a randomized comparative study of the feasibility of diagnost ic transnasal EGD and assessed the factors influencing its quality and tole rance (endoscope diameter or route). Methods: Transnasal EGD was attempted in 100 patients to assess its feasibi lity. For the analysis of quality and tolerance, 150 patients were randomiz ed as follows into 3 groups according to the route of examinations: (1) ora l route with 9.8 mm diameter standard videoendoscope; (2) oral route with 6 .0 mm diameter pediatric videoendoscope; (3) transnasal route with 6.0 mm d iameter pediatric videoendoscope. The operator assessed the quality of exam ination by standard scores. Patients quantified pain intensity, nausea, and choking sensation. Results: Transnasal EGD was feasible in 82% of patients. The quality of the examination was significantly lower with pediatric endoscope. No differenc e was noted concerning pain intensity, but nausea and choking sensation wer e significantly reduced when the nasal route was used. Conclusions: Transnasal EGD is feasible in the routine practice of diagnost ic EGD. The nasal route, and not endoscope diameter (6.0 mm vs 9.8 mm diame ter), is the determining factor that explains increased patient tolerance d uring transnasal EGD. Technical improvements in pediatric videoendoscopes a re required.