A comparative study of unsedated transnasal esophagogastroduodenoscopy and conventional EGD.
BACKGROUND
A significant portion of the cost and complications associated with conventional esophagogastroduodenoscopy (EGD) is attributed to conscious intravenous sedation, which usually results in loss of work on the day of the endoscopy. Earlier studies have described the feasibility and safety of unsedated transnasal EGD in normal volunteers.


METHODS
We compared the diagnostic yield and patient acceptability of this new technique performed first, with conventional EGD performed second in 24 outpatients.


RESULTS
The sensitivity of transnasal EGD was 89% and its specificity was 97%. Transnasal EGD was more acceptable and less stressful to the patients than conventional EGD (p < 0.05). Oxygen saturation and blood pressure did not change during transnasal EGD.


CONCLUSIONS
Transnasal EGD is feasible, safe, and well tolerated by patients. Specificity of transnasal EGD is similar to, but its sensitivity is lower than, conventional EGD. By eliminating the need for sedation-related work loss and postprocedural monitoring, transnasal EGD potentially is more cost-effective than conventional EGD.
MCW Dysphagia Institute, Medical College of Wisconsin, Zablocki VA Medical Center, Milwaukee, USA.
R
R
Dean
K
K
Dua
B
B
Massey
W
W
Berger
W J
WJ
Hogan
R
R
Shaker
D000328:Adult; D000368:Aged; D016292:Procedural Sedation / Q000191:economics; D003365:Costs and Cost Analysis; D004384:Duodenoscopy / Q000191:economics / Q000379:methods; D016145:Endoscopy, Digestive System / Q000191:economics / Q000379:methods*; D004945:Esophagoscopy / Q000191:economics / Q000379:methods; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000473:pathology; D005773:Gastroscopy / Q000191:economics / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D017060:Patient Satisfaction; D012680:Sensitivity and Specificity