Unsedated transnasal EGD in daily practice: results with 1100 consecutive patients.
BACKGROUND
EGD can be performed transnasally in adults by using small-diameter endoscopes. A large prospective study was conducted to evaluate the feasibility and tolerance of diagnostic transnasal EGD in daily practice.


METHODS
Unsedated transnasal EGD was attempted in 1100 consecutive patients, in 3 different institutions, by using a 5.9-mm or a 5.3-mm diameter endoscope. The operator determined whether the procedure was successful or unsuccessful, the reason for failures, and any side effects. The influence of gender, age, endoscope diameter, and type of topical anesthesia on the success or failure of the procedure was evaluated. Patients who previously had undergone peroral EGD were queried as to which procedure they preferred.


RESULTS
Transnasal EGD was feasible in 93.9% of the patients. The causes of failure were as follows: unsuccessful transnasal insertion (62.7%), patient refusal (19.4%), and nasal pain (17.9%). Female gender, young age (< or =35 years), and larger-endoscope diameter were significant predictive factors for procedure failure. Side effects included the following: epistaxis (2.3%), nasal pain (1.6%), and vaso-vagal reaction (0.3%). A majority (91%) of the patients who previously had undergone unsedated peroral EGD with a standard 9.8-mm diameter endoscope preferred transnasal EGD with a small-diameter endoscope.


CONCLUSIONS
Transnasal EGD is feasible in daily endoscopic practice and is preferred by patients. Side effects are rare.
Dumortier
Jérôme
J
Department of Digestive Diseases, Hôpital Edouard Herriot, Lyon, France.
Napoleon
Bertrand
B
Hedelius
Franck
F
Pellissier
Pierre-Edouard
PE
Leprince
Eric
E
Pujol
Bertrand
B
Ponchon
Thierry
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D015331:Cohort Studies; D016292:Procedural Sedation; D004066:Digestive System Diseases / Q000175:diagnosis; D019723:Endoscopes; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods*; D004867:Equipment Design; D004869:Equipment Safety; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009296:Nasal Cavity; D010147:Pain Measurement; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D011336:Probability; D018570:Risk Assessment; D012680:Sensitivity and Specificity