Unsedated transnasal EGD: an alternative approach to conventional esophagogastroduodenoscopy for documenting Helicobacter pylori eradication

Background: The aim of this study was to assess the yield of antral biopsie s performed via unsedated transnasal esophagogastroduodenoscopy, a techniqu e that does not require conscious sedation with its concomitant costs and c omplications, for documentation of Helicobacter pylori eradication. Methods: Nineteen patients who were previously CLO test positive on convent ional esophagogastroduodenoscopy and subsequently treated for H pylori infe ction were enrolled. The subjects had not received antibiotic therapy in th e prior month and had no prior gastric surgery. By using a GIF-N30 fiberopt ic endoscope and a tiny cup biopsy forceps (1.8 mm diameter), unsedated tra nsnasal endoscopy was performed and antral biopsy specimens were taken for a CLO test, histologic analysis (Dieterle stain), and tissue culture. On th e same day, the subjects underwent a carbon 13-labeled area urea breath tes t. All subjects completed a visual analog scale, rating the acceptability o f the unsedated transnasal examination and the previous sedated conventiona l esophagogastroduodenoscopy. Results: There was no statistically significant difference between the resu lts of the CLO tests (5/19 positive) versus the C-13-urea breath test (4/19 positive) (p = 0.96), the CLO tests versus histologic findings (5/19 posit ive) (p = 0.71), or the C-13-urea breath test versus histologic findings (p = 0.96). All tissue culture results were negative. The overall acceptabili ty of unsedated transnasal esophagogastroduodenoscopy was similar to that o f sedated conventional esophagogastroduodenoscopy. Conclusion: Unsedated transnasal esophagogastroduodenoscopy, a technique th at eliminates the costs and complications associated with conscious sedatio n, is a feasible and accurate alternative to conventional esophagogastroduo denoscopy when documentation of H pylori eradication and confirmation of ga stric ulcer healing are both indicated.