Introduction Transnasal upper gastrointestinal endoscopy (TNE) using ultrathin endoscopes is considered less invasive, thus an attractive alternative, if not a first choice option, for diagnostic upper endoscopy. This is the first prospective, randomised study, in a UK population to assess tolerability, acceptability and quality of TNE, in comparison with standard upper endoscopy (SOGD) under local anaesthetic.
Methods We prospectively recruited up to date 125 patients [59 male/66 female] mean age 57 years. The Fujinon EG530N (5.9 mm) and EG530WR (9.4 mm) endoscopes were used. The endoscopist and all patients completed detailed questionnaires regarding tolerability, acceptance and quality of each endoscopy using standard visual analogue scales (VAS). Oxygen saturation [SaO2], heart rate [HR] and systolic blood pressure [SBP] were recorded during procedure. SOGD group received O2 2 lt/min. Quality of biopsies was evaluated blindly by the reporting pathologists.
Results Trial interim analysis included 129 endoscopies in 125 patients [TNE=65, SOGD=64]. In all patients intubation of D2 was achieved. VAS scores for patient comfort (higher score=greater comfort) were significantly better in the TNE compared to SOGD group (7 vs 5.6, respectively, p=0.0013). 40 patients had previous experience of standard endoscopy, and 22(55%) reported gagging as main reason of discomfort. 22/40 were randomised to TNE. 21 of these 22 patients [95.5%] stated preference to transnasal endoscopy in the future. Gagging score (higher score=more gagging) was significantly less in the TNE compared with SOGD group (0.05 vs 3.22 respectively, p2 (98 % vs 98.3%, respectively, p=0.22). Only 2 (5.4%) of TNE biopsies did not permit a definite diagnosis, but when standard biopsies were later taken, also failed to confirm diagnosis.
Conclusion TNE is equal to SOGD in image quality, endoscope handling and length of procedure. It is superior to SOGD in the ability to perform a panendoscopy and in terms of comfort and patient acceptance. Importantly it induced significantly less stress to the heart, thus should be considered as the endoscopic diagnostic method of choice in patients with significant cardio-respiratory problems.
Competing interests E Alexandridis conflict with: fellowship received from Fujinon, Imotech, K Trimble: None declared, P Hayes: None declared, J Plevris grant/research support from: Fujinon, Imotech, Conflict with: Fuji Provided Loan Equipment for trial.