A pilot study assessing tolerance safety and feasibility of diagnostic transnasal esophagogastroduodenoscopy using an improved larger caliber endoscope and an adapted topical anesthesia



Transnasal esophagogastroduodenoscopy (TN-EGDS) is well tolerated by patients and the examination is perceived comfortable without the need of a sedative drug. Conversely, mainly in Western literature, some authors report limitations in illumination, image quality, and working channel as affecting TN-EGDS diffusion. To overcome these disadvantages, a new transnasal endoscope (TNE) was tested but, due to its larger diameter, we have no evidence of its clinical safety and tolerability. A new adapted nasal anesthesia could be useful to improve TNE tolerance. In an independent, not sponsored, pilot prospective study we enrolled, in a busy clinical hospital setting, 30 adult patients receiving nasal atomized Lidocaine and Xylometazoline (XAL) to undergo a diagnostic TN-EGDS with TNE to evaluate its tolerance, safety, and feasibility.


Three physicians enrolled inpatients and outpatients with indication to diagnostic EGDS during a 6-month period. Main outcome measures were cardio-pulmonary monitoring data and patients’ answers to an adapted questionnaire investigating pain, anxiety level, willingness to repeat the examination, operators’ scores about endoscopy quality, examination conduction and anesthesia-related complications.


The examination was completed by the transnasal route in 100 % of the enrolled patients, endoscopy satisfaction and feasibility were scored to nearly the highest levels by the three different physicians. A total of 29/30 patients (96.6 %) declared the willingness to repeat the same examination if needed. The mean patients’ score for overall pain was 3.7 ± 1 SD (range 1–10 by Visual Analog Scale). Mean endoscopy duration was 11.1 ± 2.6 min (range 5.0–19.0). In a total of 17/30 TN-EGDS that lasted more than 11 min, higher heart frequency variations and worse tolerance scores were found (p < 0.05).


Our pilot study demonstrates that TN-EGDS with TNE and NA is safe, well tolerated, and feasible. The best clinical tolerance is reached when TN-EGDS lasts <11 min.

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We are grateful to Prof. Leonardo Palombi for the statistical review and to Paola Rosati for her editing advice during the final submission.


Balassone Valerio, Dauri Mario, Cappuccio Roberto, Di Camillo Mauro, Benavoli Domenico, Buonomo Oreste, Petrella Giuseppe, and Stroppa Italo have no conflicts of interest or financial ties to disclose.

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Correspondence to Valerio Balassone.

Electronic supplementary material

Below is the link to the electronic supplementary material. Video 1 Major findings selected from TN-EGDS of patients included in the study.

Supplementary material 1 (WMV 38429 kb)

Supplementary material 1 (WMV 38429 kb)

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Balassone, V., Dauri, M., Cappuccio, R. et al. A pilot study assessing tolerance safety and feasibility of diagnostic transnasal esophagogastroduodenoscopy using an improved larger caliber endoscope and an adapted topical anesthesia. Surg Endosc 29, 3002–3009 (2015).

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  • Endoscopy
  • Feasibility
  • Nose
  • Patient compliance
  • Safety