Transnasal gastroscopy compared to conventional gastroscopy: A randomized study of feasibility, safety, and tolerance

Background and Study Aims: Gastroscopy is often an unpleasant procedure for the patient. Sedation improves the tolerance, but it causes inconvenience. both for patients and for endoscopy units. The aim of the present study was to compare the feasibility, safety and tolerance of transnasal gastroscopy using a thin endoscope with conventional oral gastroscopy. Patients and Methods: One hundred eighty-one consecutive outpatients referred for diagnostic gastroscopy were randomized to undergo transnasal or oral conventional gastroscopy. The tolerance (discomfort, retching, throat pain, and desire for sedation in any further procedures) and examination difficulty (intubation, examination, aspiration, and visibility) were assessed by the patients and the endoscopists, respectively, using visual analogue scales and a questionnaire, Results: 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 further examinations, compared to 15% in the conventional oral gastroscopy 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 endoscope were considered more difficult by the endoscopists. Conclusions: Nasal introduction of thin endoscopes is better tolerated by patients than conventional gastroscopy: minimizing the need for sedation. However, technical improvements in thin endoscopes (a wider working channel, increased length and better image quality) would increase their usefulness.