Unsedated transnasal versus transoral sedated upper gastrointestinal endoscopy: a one-series prospective study on safety and patient acceptability.
BACKGROUND
While conventional oesophagogastroduodenoscopy is frequently performed under sedation to improve acceptability, transnasal oesophagogastroduodenoscopy would appear to be less invasive.


OBJECTIVE
To compare diagnostic accuracy, feasibility, acceptability and safety of transnasal oesophagogastroduodenoscopy without sedation versus conventional oesophagogastroduodenoscopy under sedation.


METHODS
Following anxiety assessment, 30 dyspeptic patients underwent transnasal oesophagogastroduodenoscopy under local anaesthesia (lidocaine) and conventional oesophagogastroduodenoscopy under conscious sedation (i.v. midazolam) on two consecutive days. Transnasal oesophagogastroduodenoscopy was performed with an ultrathin and conventional oesophagogastroduodenoscopy with a standard endoscope.


METHODS
Safety, evaluated by monitoring cardio-respiratory functions. Acceptability, rated according to discomfort and preference between the two examinations. Diagnostic accuracy evaluated taking into account endoscopic patterns and adequacy of biopsy specimens for histology. Feasibility, defined according to endoscopic performance, quality of images and overall opinion of the endoscopist. Only gastric biopsies were evaluated.


RESULTS
All patients but one who refused conventional oesophagogastroduodenoscopy underwent both transnasal oesophagogastroduodenoscopy and conventional oesophagogastroduodenoscopy. No cardiorespiratory complications occurred during either technique. Majority of patients (87%) preferred transnasal oesophagogastroduodenoscopy. Examinations were completed in all cases, with comparable endoscopic patterns. All biopsy specimens were suitable for histology.


CONCLUSIONS
Transnasal oesophagogastroduodenoscopy without sedation provides good diagnostic accuracy, is safer and better accepted than conventional oesophagogastroduodenoscopy under sedation and, therefore, represents a valid alternative in routine diagnosis of upper digestive tract diseases.
Stroppa
I
I
Gastrointestinal Unit, Department of Internal Medicine, Tor Vergata University, Rome, Italy. italo.stroppa@ptvonline.it
Grasso
E
E
Paoluzi
O A
OA
Razzini
C
C
Tosti
C
C
Andrei
F
F
Biancone
L
L
Palmieri
G
G
Romeo
F
F
Pallone
F
F
D000328:Adult; D000704:Analysis of Variance; D016292:Procedural Sedation / Q000379:methods*; D004066:Digestive System Diseases / Q000175:diagnosis*; D020698:Duodenoscopes; D016145:Endoscopy, Digestive System / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D020701:Esophagoscopes; D005260:Female; D020699:Gastroscopes; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth; D009296:Nasal Cavity; D010147:Pain Measurement; D017060:Patient Satisfaction; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D017751:Safety Management; D012680:Sensitivity and Specificity