title: Is the transnasal access for esophagogastroduodenoscopy in routine use equal to the transoral route? A prospective, randomized trial.
abstract: OBJECTIVE
  Routine esophagogastroduodenoscopy (EGD) is increasingly performed without sedation. Transoral (TO) and transnasal (TN) EGD offer different patient comfort and complications.
  
  
  METHODS
  For a controlled, randomized, clinical trial comparing TN-EGD with TO-EGD without sedation, patients were assigned to TN-EGD using a thin endoscope (group 1, 93 patients), or TO-EGD using a standard endoscope (group 2, 90 patients). Physician-rated procedural time and complications as well as patient-rated side effects and preferences were compared. In group 3, patients (118) who had previously undergone TO-EGD, now underwent TN-EGD.
  
  
  RESULTS
  Between group 1 and 2 there was no significant difference for procedural time. Nausea (p = 0.047) and epistaxis (p < 0.001) were significantly more frequent for TN-EGD. Conversion rate from TN- to TO-EGD was low with 4.3 %. For TN-EGD, patients' tolerance was better (p < 0.001), gagging was less (p < 0.001). In case of a future EGD, patients who know both procedures (group 3), strongly vote for TN-EGD (80 %). All groups vote against sedation for future procedures (90 %/90 %/89 %).
  
  
  CONCLUSIONS
  Epistaxis can be relevant after TN-EGD, but can mostly be managed conservatively. TN-EGD is superior to TO-EGD regarding subjective and objective gagging as well as procedural tolerance. Patients who experienced both access routes, prefer TN-EGD. TN-EGD without sedation should be aspired for patient comfort and is recommended for routine use.
authors.affiliation: Department of Abdominal, Vascular and Transplant Surgery, University Witten/Herdecke, Medical Center Cologne Merheim, Cologne.
authors.forename: J
authors.initials: J
authors.lastname: Knuth
authors.affiliation: Clinic for Radiation Therapy, University Hospital of Cologne, Cologne.
authors.forename: D E
authors.initials: DE
authors.lastname: Kunze
authors.affiliation: Clinic for Internal Medicine, Evangelic Hospital Cologne-Weyertal, Cologne.
authors.forename: C
authors.initials: C
authors.lastname: Benz
authors.affiliation: Department of Abdominal, Vascular and Transplant Surgery, University Witten/Herdecke, Medical Center Cologne Merheim, Cologne.
authors.forename: D R
authors.initials: DR
authors.lastname: Bulian
authors.affiliation: Department of Abdominal, Vascular and Transplant Surgery, University Witten/Herdecke, Medical Center Cologne Merheim, Cologne.
authors.forename: M M
authors.initials: MM
authors.lastname: Heiss
authors.affiliation: Institute for Research in Operative Medicine (IFOM), Cologne, University Witten/Herdecke, Cologne.
authors.forename: R
authors.initials: R
authors.lastname: Lefering
authors.affiliation: Clinic for General-, Visceral-, Vascular and Thoracic Surgery, District Hospital Gummersbach.
authors.forename: S
authors.initials: S
authors.lastname: Saad
authors.affiliation: Medical Department I: Nephrology, Gastroenterology & Transplant Medicine, University Witten/ Herdecke, Medical Center Cologne Merheim, Cologne.
authors.forename: T
authors.initials: T
authors.lastname: Saers
authors.affiliation: Medical Department I: Nephrology, Gastroenterology & Transplant Medicine, University Witten/ Herdecke, Medical Center Cologne Merheim, Cologne.
authors.forename: B
authors.initials: B
authors.lastname: Krakamp
mesh_terms: D003955:Diagnostic Tests, Routine / Q000009:adverse effects / Q000379:methods; D016145:Endoscopy, Digestive System / Q000009:adverse effects* / Q000379:methods*; D004844:Epistaxis / Q000209:etiology*; D005260:Female; D005683:Gagging; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth; D009325:Nausea / Q000209:etiology*; D009666:Nose; D010146:Pain / Q000209:etiology*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology*