Upper endoscopy is an integral component in the management of upper gastrointestinal disorders, but it is underutilized because of its high cost and potential complications. Unsedated transnasal endoscopy (T-EGD) is a relatively new technique using an ultrathin endoscope. Because it is better tolerated than standard upper endoscopy, it is performed with the patient unsedated, thus avoiding the associated costs and complications of conscious sedation. In this review, the technique of T-EGD and its current experience are discussed. In addition, potential future applications, special considerations, and potential pitfalls are reviewed.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
References and Recommended Reading
Van Dam J, Brugge WR: Endoscopy of the upper gastrointestinal tract. N Engl J Med, 341:1738–1748.
Wang TH, Lin JT: Worldwide use of sedation and analgesia for upper intestinal endoscopy: sedation for upper GI endoscopy in Taiwan. Gastrointest Endosc 1999, 50:888–889.
Iber FL, Sutberry M, Gupta R, Kruss D: Evaluation of complications during and after conscious sedation for endoscopy using pulse oximetry. Gastrointest Endosc 1993, 39:620–625.
Shapira M, Tamir A: Presence of family member during upper endoscopy. J Clin Gastroenterol 1996, 22:272–274.
Hackett ML, McCarthy DC: Upper gastrointestinal endoscopy: are preparatory interventions effective? Gastrointest Endosc 1998, 48:341–347.
Hart R, Classen M: Complications of diagnostic gastrointestinal endoscopy. Endoscopy 1990, 22:22–33.
Arrowsmith JB, Gerstman BB, Fleischer DE, Benjamin SB: Results from the American Society for Gastrointestinal Endoscopy/US Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc 1991, 37:421–427. Retrospective analysis of complications of gastrointestinal endoscopy.
Wille RT, Chaffee BW, Ryan ML, et al.: Pharmacoeconomic evaluation of flumazenil for routine outpatient EGD. Gastrointest Endosc 2000, 51:282–287.
Chang AC, Solinger MA, Yang DT, Cheng YK: Impact of flumazenil on recovery after outpatient endoscopy; a placebo-controlled trial. Gastrointest Endosc 1999, 49:573–579.
Froehlich F, Pache I, Burnand B, et al.: Underutilization of upper gastrointestinal endoscopy. Gastroenterology 1997, 112:690–697.
Froehlich F, Burnand B, Pache I, et al.: Overuse of upper gastrointestinal endoscopy in a country with open-access endoscopy: a prospective study in primary care. Gastrointest Endosc 1997, 45:13–19.
American Gastroenterological Association Clinical Practice and Practice Economics Committee Literature Review: American Gastroenterological Association medical position statement: evaluation of dyspepsia. Gastroenterology 1998, 114:579–581.
Jones R: What happens to patients with non-ulcer dyspepsia after endoscopy? Practitioner 1988, 232:75–78.
Wiklund I, Glise H, Jerndal P, et al.: Does endoscopy have a positive impact on quality of life in dyspepsia? Gastrointest Endosc 1998, 47:449–454.
Jones R, Lydeard S: Dyspepsia in the community: a follow-up study. Br J Clin Pract 1992, 46:95–97.
Hansen JM, Bytzer P, Bondesen S, et al.: Efficacy and outcome of an open access endoscopy service. Dan Med Bull 1991, 38:288–290.
Johannessen T, Petersen H, Kleveland PM, et al.: The predictive value of history in dyspepsia. Scand J Gastroenterol 1990, 25:689–697.
Fendrick AM, Chernew ME, Hirth RA, Bloom BS: Alternative management strategies for patients with suspected peptic ulcer disease. Ann Intern Med 1995, 123:260–268.
Saeian K, Fendrick AM, Shaker R: Impact of unsedated transnasal endoscopy (T-EGD) on the management of dyspepsia: a decision analysis [abstract]. Gastroenterology 2001, 120:A1240.
Inadomi JM, Lieberman D, Lagergren J, et al.: Costeffectiveness of once in a lifetime screening unsedated endoscopy in 50-year-old white males with uncomplicated GERD [abstract]. Gastroenterology 2001, 120:A2116.
Pereira S, Hussaini SH, Hanson PJ, et al.: Endoscopy: throat spray or sedation? J R Coll Physicians Lond 1994, 28:411–414.
Shaker R: Unsedated trans-nasal pharyngoesophagogastroduodenoscopy (T-EGD): technique. Gastrointest Endosc 1994, 40:346–348. The original description of the T-EGD technique utilizing an ultrathin endoscope in a group of volunteers.
Craig A, Hanlon J, Dent J, Schoeman M: A comparison of transnasal and transoral endoscopy with small-diameter endoscopes in unsedated patients. Gastrointest Endosc 1999, 49:292–296.
Dumortier J, Ponchon T, Scoazec JY, et al.: Prospective evaluation of transnasal esophagogastroduodenoscopy: feasibility and study on performance and tolerance. Gastrointest Endosc 1999, 49:285–291. Report from a French study that evaluated the feasibility of T-EGD and also compared the tolerability of T-EGD (6.0-mm endoscope) with peroral standard (9.8-mm endoscope) and peroral ultrathin (6.0-mm endoscope) endoscopy. Better tolerability in the form of decreased nausea and choking were noted with the transnasal route.
Zaman A, Hahn M, Hapke R, et al.: A randomized trial of peroral versus transnasal unsedated endoscopy using an ultrathin videoendoscope. Gastrointest Endosc 1999, 49:279–284.
Dean R, Dua K, Massey B, et al.: A comparative study of unsedated transnasal esophagogastroduodenoscopy and conventional EGD. Gastrointest Endosc 1996, 44:422–424. A comparison of the yield of unsedated T-EGD and standard peroral endoscopy in a group of 24 outpatients. One small nodule at the cardia and one subtle ring at the gastroesophageal junction were missed by T-EGD in the early phase of the study.
Choi H, Shaffer PA: Assessing the effectiveness of prevention: a case study [Appendix D]. In Prevention Effectiveness: A Guide to Decision Analysis and Economic Evaluation. Edited by Haddix AC, Teutsch SM, Shaffer PA, Dunet DA. New York: Oxford University Press; 1996:162–171.
Saeian K, Townsend WF, Rochling FA, et al.: Unsedated transnasal esophagogastroduodenoscopy: a feasible alternative for documenting Helicobacter pylori eradication. Gastrointest Endosc 1999, 49:297–301.
Saeian K, Staff DM, Vasilopoulos S, et al.: Unsedated transnasal endoscopy accurately detects Barrett’s metaplasia and dysplasia. Gastrointest Endosc, in press.
Saeian K, D Staff, J Knox, et al.: Unsedated transnasal EGD (T-EGD): a new technique for accurately detecting and grading esophageal varices in cirrhotic patients. Am J Gastroenterol, in press.
Mokhashi M, Van Velse A, Sahai AV, et al.: Large scale screening for reflux esophagitis and Barrett’s: a reality with a new battery powered, super-thin stand-alone esophagoscope [abstract]? Gastrointest Endosc 1999, 49:AB157.
Assy N, Rosser BG, Grahame GR, Minuk GY: Risk of sedation for upper GI endoscopy exacerbating subclinical encephalopathy in patients with cirrhosis. Gastrointest Endosc 1999, 49:690–694.
Zangara PD, Heller T, Haluszka O, Larrin J: Unsedated esophagogastroscopy for the diagnosis of esophageal varices in patients with cirrhosis. Endoscopy 2000, 32:971–973.
Sorbi D, Gostout W, Henry J, Lindor KD: Unsedated smallcaliber esophago-gastroduodenoscopy (EGD) versus conventional EGD: a comparative study. Gastroenterology 1999, 117:1301–1307.
Dua KS, Ruan E, Shaker R: Transnasal pharyngoesophagogastroduodenoscopy (T-PEGD) in a patient with acute upper gastrointestinal bleeding. Endoscopy 1996, 28:530.
Kulling D, Bauerfeind P, Fried M: Transnasal versus transoral endoscopy for the placement of nasoenteral feeding tubes in critically ill patients. Gastrointest Endosc 2000, 52:506–510.
Campo R, Brullet E, Montserrat A, et al.: Topical pharyngeal anesthesia improves tolerance of upper gastrointestinal endoscopy: a randomized double-blind study. Endoscopy 1995, 27:659–664.
Dhir V, Swaroop VS, Vazifdar KG, Wagle SD: Topical pharyngeal anesthesia without intravenous sedation during upper gastrointestinal endoscopy. Indian J Gastroenterol 1997, 16:10–11.
Hedenbro JL, Ekelund M: Endoscopic perforation in unsedated patients undergoing endoscopy. Br J Surg 1996, 83:845–846.
Fisher NC, Bailey S, Gibson JA: A prospective, randomized controlled trial of sedation vs no sedation in outpatient diagnostic upper gastrointestinal endoscopy. Endoscopy 1998, 30:21–24.
About this article
Cite this article
Saeian, K. Unsedated transnasal endoscopy: A safe and less costly alternative. Curr Gastroenterol Rep 4, 213–217 (2002). https://doi.org/10.1007/s11894-002-0065-4
- Esophageal Varix
- Gastrointestinal Endoscopy
- Conscious Sedation