title: Transnasal endoscopy is preferred by transoral endoscopy experienced patients.
abstract: OBJECTIVE
  Both unsedated transoral endoscopy (TOE) and sedated TOE have some drawbacks in clinical practice. Unsedated transnasal endoscopy (TNE) has been suggested as an alternative to both methods. This study aimed to determine the advantages of TNE in patients who have previously undergone unsedated conventional TOE.
  
  
  METHODS
  Patients who had received an unsedated TOE in the last 12 months and were scheduled for a second upper endoscopy were included. They were randomized to undergo either unsedated TOE, using a standard endoscope, or unsedated TNE, using an ultrathin endoscope. Post-procedure, patients were asked to complete a questionnaire to assess pain, discomfort and acceptability of the procedure, and to compare the current procedure with their previous unsedated TOE. Endoscope insertion rate, procedure duration, and side-effects were recorded.
  
  
  RESULTS
  Each group included 50 patients. With the exception of nasal pain, the tolerability and acceptance were significantly greater in the unsedated TNE group. Significantly more TNE patients (82%) found the current endoscopic procedure to be better than their previous TOE when compared with patients who had received a second TOE (12%). A repeat procedure was significantly more acceptable for TNE patients when compared to the TOE group (68% vs.16%). The duration of endoscopy was significantly shorter in TOE than in TNE (p<0.05). Endoscope insertion failed in 4% and mild epistaxis was observed in 4% of TNE patients.
  
  
  CONCLUSIONS
  Unsedated TNE was better tolerated in endoscopy experienced patients when compared with unsedated TOE. The majority of patients found TNE more acceptable and preferable to TOE, suggesting that TNE should become a more common practice in clinics when applicable.
authors.affiliation: Division of Gastroenterology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey. akadayifci@mgh.harvard.edu; kadayifci@hotmail.com.
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Kadayifci
authors.affiliation: Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Atar
authors.affiliation: Department of Internal Medicine Nursing, Faculty of Health Science, University of Gaziantep, Gaziantep, Turkey.
authors.forename: Serap
authors.initials: S
authors.lastname: Parlar
authors.affiliation: Division of Gastroenterology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Balkan
authors.affiliation: Division of Gastroenterology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey.
authors.forename: Irfan
authors.initials: I
authors.lastname: Koruk
authors.affiliation: Division of Gastroenterology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Koruk
mesh_terms: D000328:Adult; D016292:Procedural Sedation; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth; D009296:Nasal Cavity; D010146:Pain / Q000209:etiology; D010147:Pain Measurement / Q000379:methods; D057240:Patient Preference; D011446:Prospective Studies; D014421:Turkey