TRANSNASAL GASTROSCOPY COMPARED TO CONVENTIONAL GASTROSCOPY - A RANDOMIZED STUDY OF FEASIBILITY, SAFETY, AND TOLERANCE

Background and Study Aims: Gastroscopy is often an unpleasant procedur e for the patient. Sedation improves the tolerance, but it causes inco nvenience. both for patients and for endoscopy units. The aim of the p resent study was to compare the feasibility, safety and tolerance of t ransnasal gastroscopy using a thin endoscope with conventional oral ga stroscopy. Patients and Methods: One hundred eighty-one consecutive ou tpatients referred for diagnostic gastroscopy were randomized to under go transnasal or oral conventional gastroscopy. The tolerance (discomf ort, retching, throat pain, and desire for sedation in any further pro cedures) and examination difficulty (intubation, examination, aspirati on, and visibility) were assessed by the patients and the endoscopists , respectively, using visual analogue scales and a questionnaire, Resu lts: Endoscope insertion failed in six patients (four transnasal, two conventional). The tolerance was significantly better with transnasal gastroscopy in comparison to conventional oral gastroscopy. Only 3% of patients undergoing transnasal gastroscopy desired sedation in any fu rther examinations, compared to 15% in the conventional oral gastrosco py group (P = 0.01). The examination time was longer in the transnasal group (5 min 25 sec + 1 min 46 sec vs. 3 min 22 sec +/-1 min 9 sec, P <0.001). Visualization capability and aspiration using the thin endosc ope were considered more difficult by the endoscopists. Conclusions: N asal introduction of thin endoscopes is better tolerated by patients t han conventional gastroscopy: minimizing the need for sedation. Howeve r, technical improvements in thin endoscopes (a wider working channel, increased length and better image quality) would increase their usefu lness.