title: Unsedated transnasal esophagoscopy for monitoring therapy in pediatric eosinophilic esophagitis.
abstract: OBJECTIVE
  Unsedated transnasal endoscopy (TNE) is safer and less costly than sedated EGD. The aim of this study was to evaluate the performance of TNE with biopsies in monitoring the esophageal mucosa of pediatric patients with eosinophilic esophagitis.
  
  
  METHODS
  Patients between 8 and 17 years of age with eosinophilic esophagitis and their parents were enrolled. Unsedated TNE was performed. A 2.8-mm (1.2-mm channel) or a 4-mm flexible bronchoscope (2-mm channel) was used, and esophageal biopsy specimens were obtained. Biopsy specimen analysis, duration, adverse events, and billing charges of TNE were assessed. Immediately after TNE and a minimum of 2 weeks later, a modified Group Health Association of America 9 survey and a preference questionnaire were completed, respectively.
  
  
  RESULTS
  Twenty-one of 22 enrolled patients underwent TNE. TNE was performed with no serious adverse events. Histopathological analysis revealed 0 eosinophils per high-power field (n = 12), fewer than 15 eosinophils per high-power field (n = 4), and more than 15 eosinophils per high-power field (n = 5). The total epithelial surface area of mucosal biopsy samples from either TNE Forceps (1.2 mm or 2 mm biopsy channel forceps) compared with those obtained during the subject's previous EGD by using standard endoscopic forceps was not statistically different (P = .308 [1.2 mm]/P = .492 [2 mm]). All parents and 76.2% of subjects would undergo the TNE again. TNE was preferred over EGD by 85.7% of parents and 52.4% of subjects. The modified Group Health Association of America 9 survey revealed a high degree of satisfaction (average, 43.19 ± 2.6; maximum score, 45). Charges associated with TNE were 60.1% lower than for previous EGDs.
  
  
  CONCLUSIONS
  Unsedated TNE is an effective, lower-cost procedure for monitoring the esophageal mucosa of children with eosinophilic esophagitis.
authors.affiliation: Digestive Health Institute, Children's Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA; Aerodigestive Program, Children's Hospital Colorado, Aurora, Colorado, USA.
authors.forename: Joel A
authors.initials: JA
authors.lastname: Friedlander
authors.affiliation: Aerodigestive Program, Children's Hospital Colorado, Aurora, Colorado, USA; Breathing Institute, Children's Hospital Colorado, Section of Pulmonary Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Emily M
authors.initials: EM
authors.lastname: DeBoer
authors.affiliation: Digestive Health Institute, Children's Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA; Aerodigestive Program, Children's Hospital Colorado, Aurora, Colorado, USA.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Soden
authors.affiliation: Digestive Health Institute, Children's Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA; Gastrointestinal Eosinophilic Diseases Program, Children's Hospital of Colorado, Aurora, Colorado, USA.
authors.forename: Glenn T
authors.initials: GT
authors.lastname: Furuta
authors.affiliation: Digestive Health Institute, Children's Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA; Gastrointestinal Eosinophilic Diseases Program, Children's Hospital of Colorado, Aurora, Colorado, USA.
authors.forename: Calies D
authors.initials: CD
authors.lastname: Menard-Katcher
authors.affiliation: Gastrointestinal Eosinophilic Diseases Program, Children's Hospital of Colorado, Aurora, Colorado, USA; Allergy Section, Children's Hospital Colorado, Section of Allergy, Immunology, and Rheumatology, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Atkins
authors.affiliation: Gastrointestinal Eosinophilic Diseases Program, Children's Hospital of Colorado, Aurora, Colorado, USA; Allergy Section, Children's Hospital Colorado, Section of Allergy, Immunology, and Rheumatology, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Fleischer
authors.affiliation: Digestive Health Institute, Children's Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Kramer
authors.affiliation: Aerodigestive Program, Children's Hospital Colorado, Aurora, Colorado, USA; Breathing Institute, Children's Hospital Colorado, Section of Pulmonary Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Robin R
authors.initials: RR
authors.lastname: Deterding
authors.affiliation: Division of Pediatric Pathology, Children's Hospital of Colorado, Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Kelley E
authors.initials: KE
authors.lastname: Capocelli
authors.affiliation: Aerodigestive Program, Children's Hospital Colorado, Aurora, Colorado, USA; Department of Otolaryngology, Children's Hospital Colorado, Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Prager
mesh_terms: D000293:Adolescent; D001706:Biopsy / Q000379:methods; D002648:Child; D057765:Eosinophilic Esophagitis / Q000175:diagnosis / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology* / Q000601:surgery; D008297:Male; D009055:Mouth; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D017060:Patient Satisfaction