Unsedated transnasal endoscopy experience at a tertiary referral center in India

Abstract

Background and Aims

Unsedated transnasal endoscopy (uTNE) was developed in the 1990s but has not gained widespread use. We present our experience with uTNE at a tertiary referral center in India.

Methods

A retrospective analysis was conducted with prospectively collected data of patients who underwent uTNE for predominantly diagnostic EGD at our center between January 2014 and September 2017. Patients received 2% lidocaine spray over the back of the throat, xylometazoline, and 10% lidocaine sprays in the nostril 10 minutes before uTNE. Successful completion of TNE without the need for sedation, conversion to peroral EGD (PO-EGD), epistaxis, and tolerance of the procedure compared with prior PO-EGD were the outcomes of interest. Unsedated PO-EGD (uPO-EGD) is the standard of care at our center. Logistic regression was used for analysis.

Results

Successful completion of uTNE (414/440 patients) was significantly associated with male sex (odds ratio [OR], 2.67; 95% confidence interval [CI], 1.16-6.14). Conversion to PO-EGD (4.32%) was significantly associated with age (OR, .96; 95% CI, .94-.99), year of endoscopy (OR, .44; 95% CI, .24-.82), and male sex (OR, .33; 95% CI, .12-.89) in multivariable analysis. Rate of epistaxis was 6.76%, and 93.09% of patients (229/246) tolerated uTNE better than prior PO-EGD. There were no life-threatening or major adverse events requiring prolonged hospitalization.

Conclusions

uTNE should be offered as an alternative to uPO-EGD for diagnostic EGD. Studies comparing tolerance and adverse events of uTNE with those of sedated PO-EGD are required given the costs and potential adverse events associated with sedation.