A prospective randomized study comparing transnasal and peroral 5-mm ultrathin endoscopy

Abstract

Differences in patient tolerance, acceptance, and satisfaction of esophagogastroduodenoscopy (EGD) between transnasal (TN) and peroral (PO) routes using a 5-mm video endoscope. Methods: A total of 220 enrolled patients were assigned randomly to two groups undergoing EGD—110 patients each for TN and PO. The successful rate, procedure time, and adverse events were recorded. After the procedure, patients answered a validated questionnaire of tolerance, acceptance, and satisfaction. Results: There were 6 failures (5.7%) of nasal intubation and two nasal bleeding (2%) among 105 TN-EGD procedures. All PO patients (n=102) completed EGD successfully without adverse event. Compared to PO, the procedure of TN achieved lower successful rate (94% vs. 100%, p=0.01), was complicated with epistaxis (2% vs. 0%) and took longer (mean±SD 19.9±6.1 min vs. 16.8±6.4 min, p=0.0001). The patients undergoing TN-EGD indicated less discomfort during passing pharynx (scores of 2.1±2.0 vs. 3.1±2.6, p=0.011) but more pain during inserting scope (scores of 2.2±1.6 vs. 1.5±1.8, p=0.0001). Eventually, there were no significant differences between TN and PO regarding the overall procedure discomfort (scores of 10.7±6.6 vs. 11.1±7.8 scores, p=0.9), satisfaction (scores of 41.2±4.2 vs. 41.3±4.6, p=0.91), and acceptability (87.8% vs. 94.2%, p=0.91). Conclusion: PO intubation seems an excellent alternative method when using a 5-mm ultrathin endoscopy because it achieves comparable patient tolerance, acceptance, and satisfaction as TN intubation, takes less time and causes lower intubation failure and epistaxis.

Keywords

• transnasal endoscopy
• ultrathin endoscope
• unsedated endoscopy