A COMPARISON OF TRANSNASAL AND TRANSORAL ESOPHAGOGASTRODUODENOSCOPY

Transnasal oesophagogastroduodenoscopy (OGD) with a narrow-bore endosc ope has been demonstrated to be feasible in unsedated volunteers. The aim of the study was to compare efficacy, safety, patient tolerance an d costs between this novel approach to OGD and standard sedated OGD. S ixty day patients were enrolled for either sedated transoral endoscopy with a standard calibre endoscope or for unsedated transnasal endosco py with a narrow-bore (5.3 mm diameter) endoscope. Visualization was u nsatisfactory in one examination in each group. The only complications were minor epistaxis in four of the transnasal group and oxygen desat uration below 90% in two of the sedated transoral group. On a I (very uncomfortable) to 5 (very comfortable) visual analogue scale, the mean transnasal group score was 3.09, compared with 3.86 in the transoral group (P = 0.013). In the transnasal group, mean procedure room time w as 15 min compared with 20 min in the transoral group (P < 0.0003), an d mean recovery room time was 7 min compared with 37 min (P < 0.0001). Consumable and pharmaceutical costs were reduced by 65 and 92%, respe ctively. This study demonstrates that unsedated transnasal OGD is a sa fe and effective route for OGD and has acceptable patient tolerance. T he safety and decreased recovery times offer major cost savings and th e potential for this method of OGD to become an office procedure for t he investigation of the upper gastrointestinal tract.