Early experience with unsedated ultrathin 4.9 mm transnasal gastroscopy: a pilot study.
BACKGROUND
Unsedated transnasal gastroscopy is a technique with unverified clinical advantages.


OBJECTIVE
To evaluate the efficacy and procedure times with transnasal gastroscopy by physicians with no previous experience in transnasal endoscopy.


METHODS
Unsedated transnasal gastroscopy using 4.9 mm ultrathin transnasal gastroscopes with randomization to two different biopsy forceps was prospectively evaluated during a single day in January 2008. The outcomes included patient tolerance (scale: 1, no discomfort; 10, severe discomfort), physician technical assessment (1, excellent; 10, very poor), gastric biopsy quality, adverse events and procedure times.


RESULTS
Twenty patients underwent transnasal gastroscopy. Nineteen patients (95%) successfully completed transnasal gastroscopy. The patient-reported mean (+/- SD) overall discomfort level during the procedure was 4.0+/-1.9 compared with a physician-estimated level of 3.2+/-1.7 (P=0.04). Only 10% (n=2) reported they would have preferred sedated over unsedated gastroscopy. Mean total encounter time from anesthesia to discharge was 33.5+/-9.3 min. The time from anesthesia to insertion was 7.0+/-5.3 min and from room exit to discharge 6.2+/-2.9 min. No patients who had gastric biopsies taken (zero of 14) had any of unacceptable quality. The only adverse event was distressing sensations (dyspnea, dizziness) in one patient that started during pre-endoscopy anesthetic application, persisting postendoscopy, but without any abnormalities in vital signs.


CONCLUSIONS
Assuming the adverse event was a rare reaction, early experience with unsedated ultrathin transnasal gastroscopy was an efficient, effective and well-tolerated procedure for evaluation of the upper gastrointestinal tract.
Cheung
Justin
J
Division of Gastroenterology, University of Alberta Hospital, Edmonton, Alberta, Canada. justin.cheung@ualberta.ca
Bailey
Robert
R
Veldhuyzen van Zanten
Sander
S
McLean
Ross
R
Fedorak
Richard N
RN
Morse
John
J
Millan
Mario
M
Guzowski
Tom
T
Goodman
Karen J
KJ
D000772:Anesthesia, Local / Q000379:methods*; D001706:Biopsy / Q000379:methods; D016292:Procedural Sedation; D000075202:Contraindications; D004867:Equipment Design; D005260:Female; D020699:Gastroscopes / Q000592:standards*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose; D010147:Pain Measurement; D017060:Patient Satisfaction; D010865:Pilot Projects; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000175:diagnosis*