Ravi Teja Pasam, MBBS, MPH1, Nagabhushanam Gollapalli, MD, DM2, Bhaskar Rao Uppala, MD, DM2, Jaganmohan Rao Kodali, MBBS, MRCP2; 1Lahey Hospital and Medical Center, Burlington, MA; 2Nagarjuna Hospitals, Vijayawada, Andhra Pradesh, India
Introduction: Transnasal endoscopy (TNE) has been used for diagnostic and therapeutic purposes for a long time now. We present our experience with TNE with respect to completion rate, tolerance of procedure compared to prior per-oral endoscopy experience, epistaxis, and complications from the procedure. Methods: This is a prospective observational study of patients who presented to our center for upper endoscopy and who consented to TNE between 01/01/2014 to 09/30/2017. All patients received xylometazoline and 10% lidocaine sprays in the nostril and 2% lidocaine spray over the back of the throat 10 minutes before the start of TNE. A decision to convert to per-oral endoscopy was made by the endoscopist in case of a narrow nasal passage which would have caused epistaxis/pain. We recorded the tolerance of TNE compared to prior per-oral endoscopy experience and the presence/absence of epistaxis at the end of the procedure. Results: 421/440 (95.7%) patients had successful completion of endoscopy with TNE, with the endoscopists switching to per-oral endoscopy in the rest. 1.7% of the patients required monitored anesthesia care (MAC). Additional procedures such as biopsies, jejunostomy and gastrostomy tube placement were performed in 39 patients. 27 (6.4%) patients had epistaxis (Spotting: 20; frank bleeding: 7). There were no life-threatening complications or those requiring hospitalization. Conversion to per-oral endoscopy was associated with age (OR: 0.96; 95% CI: 0.94-0.99), year of endoscopy (OR: 0.44; 95% CI: 0.24-0.82), and male sex (OR: 0.33 95% CI: 0.12-0.89) in multivariable analysis. 252 (59.9%) patients had prior per-oral endoscopy. Of those patients, 93.2% of the patients tolerated TNE better compared to their prior per-oral endoscopy experience. Tolerance of the procedure and epistaxis were not associated with age, sex, type of endoscope used, year of endoscopy, or additional procedures performed during the TNE. Discussion: Unsedated TNE is a viable, safe, effective, and valuable diagnostic alternative to per-oral endoscopy. It should be presented to all patients as an option. Patients’ ability to communicate with the endoscopist throughout the procedure, avoidance of sedation, and conservation of resources that would have been required for post-sedation monitoring are some of the advantages of TNE. We should come up with strategies to minimize minor complications like nasal pain and epistaxis. Focus on developing accessories to TNE will help its expansion to more therapeutic procedures.
Demographic and Procedural Characteristics. TNE - Transnasal endoscopy.
Findings during Transnasal endoscopy. Note: Some patients had multiple findings.
Univariable and multivariable analyses of the association between various demographic/procedural variables and conversion to per-oral endoscopy, epistaxis due to transnasal endoscopy (TNE), and tolerance of TNE compared to prior per-oral endoscopy. * - Fisher’s exact test used. OR - Odds Ratio; CI - Confidence Intervals; N/A - Not applicable.
Disclosures: Ravi Teja Pasam indicated no relevant financial relationships. Nagabhushanam Gollapalli indicated no relevant financial relationships. Bhaskar Rao Uppala indicated no relevant financial relationships. Jaganmohan Rao Kodali indicated no relevant financial relationships.