Cardiovascular tolerance in upper gastrointestinal endoscopy using an ultrathin scope: Prospective randomized comparison between transnasal and transoral procedures

Background: Transnasal esophagogastroduodenoscopy (EGD) has been suggested to be better tolerated by the cardiovascular system with a lower elevation of systolic blood pressure (BP) than oral EGD. However, limited information is available on the precise comparison of cardiovascular responses between the two endoscopic procedures using the same ultrathin scope. Methods: A prospective patient-centered randomized study was performed to examine BP, pulse rate (P) and peripheral blood oxygen saturation (SpO(2)) during nasal and oral EGD using the same ultrathin endoscope. The acceptability of EGD was also assessed using a visual analog scale. A total of 1147 patients were divided into four groups: patients who preferred oral or nasal EGD underwent endoscopy according to their preference (preferred group) and patients without preference were randomly assigned to oral and nasal EGD (randomized group). Results: The study design excluded a bias of the patient's preference. The randomized group involved 149 patients among whom 74 and 75 cases were assigned to the transnasal and oral EGD groups, respectively. The results in the randomized group confirmed a significantly lower elevation of BP in patients undergoing transnasal EGD than those undergoing oral EGD, while the increase in P was slightly smaller in patients undergoing the nasal procedure. Changes in SpO(2) were minimal in either procedure. Analyses of patient acceptability showed a favorable evaluation of nasal EGD. Conclusions: The present study confirmed less cardiovascular stress using nasal EGD than oral endoscopy when compared using the same ultrathin scope.