Advertisement

Techniques of Office-Based Endoscopy: Unsedated Transnasal Endoscopy

  • Toshitaka Hoppo
  • Blair A. JobeEmail author
Chapter

Abstract

Esophagogastroduodenoscopy (EGD) has been widely accepted as a diagnostic and therapeutic tool for the evaluation and management of foregut disease. Most of procedures are currently performed under conscious sedation in an outpatient setting to reduce patient discomfort. Conscious sedation, commonly achieved by moderate sedation with analgesia such as fentanyl and midazolam, is a depressed level of consciousness that allows patients to respond purposefully to verbal commands while continuously maintaining their own airway. However, most of the morbidity associated with EGD is related to sedation with narcotics and sedative agents (especially in older patients with cardiopulmonary disease), potentially leading to hypoxia, hypotension, cardiac arrhythmia, and respiratory failure. Sedation also requires the infrastructure and resources of specialized facilities and monitoring both during and after the procedure, which lead to significant associated cost and resource expenditure (direct costs).

Keywords

Methylene Blue Early Gastric Cancer Percutaneous Endoscopic Gastrostomy Percutaneous Endoscopic Gastrostomy Tube Epiphrenic Diverticulum 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 18.1

Transanal endoscopy (TNE) Video. This video was created by Evan Dellon. Used with permission Perry AF, et al. Feasibility, Safety, Acceptability and Yield of Office-based, Screening Transnasal Esophagoscopy, Gastrointest Endoscopy 2012 Mar 15 [Epub ahead of print]. Copyright 2012 Elesevier [66] (MPG 64768 kb)

References

  1. 1.
    Bell GD. Premedication, preparation, and surveillance. Endoscopy. 2002;34(1):2–12.PubMedCrossRefGoogle Scholar
  2. 2.
    Conlong P, Rees W. The use of hypnosis in gastroscopy: a comparison with intravenous sedation. Postgrad Med J. 1999;75(882):223–5.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Gattuso SM, Litt MD, Fitzgerald TE. Coping with gastrointestinal endoscopy: self-efficacy enhancement and coping style. J Consult Clin Psychol. 1992;60(1):133–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Woloshynowych M, Oakley DA, Saunders BP, Williams CB. Psychological aspects of gastrointestinal endoscopy: a review. Endoscopy. 1996;28(9):763–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Shaker R. Unsedated trans-nasal pharyngoesophagogastroduodenoscopy (T-EGD): technique. Gastrointest Endosc. 1994;40(3):346–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Kim CY, O’Rourke RW, Chang EY, Jobe BA. Unsedated small-caliber upper endoscopy: an emerging diagnostic and therapeutic technology. Surg Innov. 2006;13(1):31–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Rodriguez SA, Banerjee S, Desilets D, et al. Ultrathin endoscopes. Gastrointest Endosc. 2010;71(6):893–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Bosco JJ, Barkun AN, Isenberg GA, et al. Gastrointestinal endoscopes: May 2003. Gastrointest Endosc. 2003;58(6):822–30.PubMedCrossRefGoogle Scholar
  9. 9.
    Tatsumi Y, Harada A, Matsumoto T, Tani T, Nishida H. Feasibility and tolerance of 2-way and 4-way angulation videoscopes for unsedated patients undergoing transnasal EGD in GI cancer screening. Gastrointest Endosc. 2008;67(7):1021–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Dumortier J, Ponchon T, Scoazec JY, et al. Prospective evaluation of transnasal esophagogastroduodenoscopy: feasibility and study on performance and tolerance. Gastrointest Endosc. 1999;49(3 Pt 1):285–91.PubMedCrossRefGoogle Scholar
  11. 11.
    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(3 Pt 1):292–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Dean R, Dua K, Massey B, Berger W, Hogan WJ, Shaker R. A comparative study of unsedated transnasal esophagogastroduodenoscopy and conventional EGD. Gastrointest Endosc. 1996;44(4):422–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Dumortier J, Napoleon B, Hedelius F, et al. Unsedated transnasal EGD in daily practice: results with 1100 consecutive patients. Gastrointest Endosc. 2003;57(2):198–204.PubMedCrossRefGoogle Scholar
  14. 14.
    Zaman A, Hahn M, Hapke R, Knigge K, Fennerty MB, Katon RM. A randomized trial of peroral versus transnasal unsedated endoscopy using an ultrathin videoendoscope. Gastrointest Endosc. 1999;49(3 Pt 1):279–84.PubMedCrossRefGoogle Scholar
  15. 15.
    Preiss C, Charton JP, Schumacher B, Neuhaus H. A randomized trial of unsedated transnasal small-caliber esophagogastroduodenoscopy (EGD) versus peroral small-caliber EGD versus conventional EGD. Endoscopy. 2003;35(8):641–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Thota PN, Zuccaro Jr G, Vargo 2nd JJ, Conwell DL, Dumot JA, Xu M. A randomized prospective trial comparing unsedated esophagoscopy via transnasal and transoral routes using a 4-mm video endoscope with conventional endoscopy with sedation. Endoscopy. 2005;37(6):559–65.PubMedCrossRefGoogle Scholar
  17. 17.
    Trevisani L, Cifala V, Sartori S, Gilli G, Matarese G, Abbasciano V. Unsedated ultrathin upper endoscopy is better than conventional endoscopy in routine outpatient gastroenterology practice: a randomized trial. World J Gastroenterol. 2007;13(6):906–11.PubMedGoogle Scholar
  18. 18.
    Mori A, Ohashi N, Yoshida A, et al. Unsedated transnasal ultrathin esophagogastroduodenoscopy may provide better diagnostic performance in gastroesophageal reflux disease. Dis Esophagus. 2011;24(2):92–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Mori A, Ohashi N, Tatebe H, et al. Autonomic nervous function in upper gastrointestinal endoscopy: a prospective randomized comparison between transnasal and oral procedures. J Gastroenterol. 2008;43(1):38–44.PubMedCrossRefGoogle Scholar
  20. 20.
    Maffei M, Dumortier J, Dumonceau JM. Self-training in unsedated transnasal EGD by endoscopists competent in standard peroral EGD: prospective assessment of the learning curve. Gastrointest Endosc. 2008;67(3):410–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Campo R, Brullet E, Montserrat A, et al. Identification of factors that influence tolerance of upper gastrointestinal endoscopy. Eur J Gastroenterol Hepatol. 1999;11(2):201–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Trevisani L, Sartori S, Gaudenzi P, et al. Upper gastrointestinal endoscopy: are preparatory interventions or conscious sedation effective? A randomized trial. World J Gastroenterol. 2004;10(22):3313–7.PubMedGoogle Scholar
  23. 23.
    Book DT, Rhee JS, Toohill RJ, Smith TL. Perspectives in laryngopharyngeal reflux: an international survey. Laryngoscope. 2002;112(8 Pt 1):1399–406.PubMedCrossRefGoogle Scholar
  24. 24.
    Yorulmaz I, Ozlugedik S, Kucuk B. Gastroesophageal reflux disease: symptoms versus pH monitoring results. Otolaryngol Head Neck Surg. 2003;129(5):582–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Hill RK, Simpson CB, Velazquez R, Larson N. Pachydermia is not diagnostic of active laryngopharyngeal reflux disease. Laryngoscope. 2004;114(9):1557–61.PubMedCrossRefGoogle Scholar
  26. 26.
    Hickson C, Simpson CB, Falcon R. Laryngeal pseudosulcus as a predictor of laryngopharyngeal reflux. Laryngoscope. 2001;111(10):1742–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Ylitalo R, Lindestad PA, Hertegard S. Is pseudosulcus alone a reliable sign of gastroesophago-pharyngeal reflux? Clin Otolaryngol Allied Sci. 2004;29(1):47–50.PubMedCrossRefGoogle Scholar
  28. 28.
    Kendall KA, Louie S. Severe obstructive airway disorders and ­diseases: vocal fold dysfunction. Clin Rev Allergy Immunol. 2003;25(3):221–31.PubMedCrossRefGoogle Scholar
  29. 29.
    Maffei M, Dumonceau JM. Transnasal esogastroduodenoscopy (EGD): comparison with conventional EGD and new applications. Swiss Med Wkly. 2008;138(45–46):658–64.PubMedGoogle Scholar
  30. 30.
    Birkner B, Fritz N, Schatke W, Hasford J. A prospective randomized comparison of unsedated ultrathin versus standard esophagogastroduodenoscopy in routine outpatient gastroenterology practice: does it work better through the nose? Endoscopy. 2003;35(8):647–51.PubMedCrossRefGoogle Scholar
  31. 31.
    Campo R, Montserrat A, Brullet E. Transnasal gastroscopy compared to conventional gastroscopy: a randomized study of feasibility, safety, and tolerance. Endoscopy. 1998;30(5):448–52.PubMedCrossRefGoogle Scholar
  32. 32.
    Kawai T, Miyazaki I, Yagi K, et al. Comparison of the effects on cardiopulmonary function of ultrathin transnasal versus normal diameter transoral esophagogastroduodenoscopy in Japan. Hepatogastroenterology. 2007;54(75):770–4.PubMedGoogle Scholar
  33. 33.
    Stroppa I, Grasso E, Paoluzi OA, et al. Unsedated transnasal versus transoral sedated upper gastrointestinal endoscopy: a one-series prospective study on safety and patient acceptability. Dig Liver Dis. 2008;40(9):767–75.PubMedCrossRefGoogle Scholar
  34. 34.
    Jobe BA, Hunter JG, Chang EY, et al. Office-based unsedated small-caliber endoscopy is equivalent to conventional sedated endoscopy in screening and surveillance for Barrett’s esophagus: a randomized and blinded comparison. Am J Gastroenterol. 2006;101(12):2693–703.PubMedCrossRefGoogle Scholar
  35. 35.
    Gopal DV, Zaman A, Katon RM. A role for transnasal esophagogastroduodenoscopy in patients intolerant to the oral route: report of two cases. Gastrointest Endosc. 1999;49(3 Pt 1):379–81.PubMedCrossRefGoogle Scholar
  36. 36.
    Mulcahy HE, Fairclough PD. Ultrathin endoscopy in the assessment and treatment of upper and lower gastrointestinal tract strictures. Gastrointest Endosc. 1998;48(6):618–20.PubMedCrossRefGoogle Scholar
  37. 37.
    Sorbi D, Gostout CJ, Henry J, Lindor KD. Unsedated small-caliber esophagogastroduodenoscopy (EGD) versus conventional EGD: a comparative study. Gastroenterology. 1999;117(6):1301–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Hayashi Y, Yamamoto Y, Suganuma T, et al. Comparison of the diagnostic utility of the ultrathin endoscope and the conventional endoscope in early gastric cancer screening. Dig Endosc. 2009;21(2):116–21.PubMedCrossRefGoogle Scholar
  39. 39.
    Toyoizumi H, Kaise M, Arakawa H, et al. Ultrathin endoscopy versus high-resolution endoscopy for diagnosing superficial gastric neoplasia. Gastrointest Endosc. 2009;70(2):240–5.PubMedCrossRefGoogle Scholar
  40. 40.
    Horiuchi A, Nakayama Y, Hidaka N, Ichise Y, Kajiyama M, Tanaka N. Prospective comparison between sedated high-definition oral and unsedated ultrathin transnasal esophagogastroduodenoscopy in the same subjects: pilot study. Dig Endosc. 2009;21(1):24–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Eisen GM, Lieberman D, Fennerty MB, Sonnenberg A. Screening and surveillance in Barrett’s esophagus: a call to action. Clin Gastroenterol Hepatol. 2004;2(10):861–4.PubMedCrossRefGoogle Scholar
  42. 42.
    Provenzale D, Schmitt C, Wong JB. Barrett’s esophagus: a new look at surveillance based on emerging estimates of cancer risk. Am J Gastroenterol. 1999;94(8):2043–53.PubMedCrossRefGoogle Scholar
  43. 43.
    Shaheen NJ, Provenzale D, Sandler RS. Upper endoscopy as a screening and surveillance tool in esophageal adenocarcinoma: a review of the evidence. Am J Gastroenterol. 2002;97(6):1319–27.PubMedCrossRefGoogle Scholar
  44. 44.
    Saeian K, Staff DM, Vasilopoulos S, et al. Unsedated transnasal endoscopy accurately detects Barrett’s metaplasia and dysplasia. Gastrointest Endosc. 2002;56(4):472–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Saeian K, Staff D, Knox J, et al. Unsedated transnasal endoscopy: a new technique for accurately detecting and grading esophageal varices in cirrhotic patients. Am J Gastroenterol. 2002;97(9):2246–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Dranoff JA, Angood PJ, Topazian M. Transnasal endoscopy for enteral feeding tube placement in critically ill patients. Am J Gastroenterol. 1999;94(10):2902–4.PubMedCrossRefGoogle Scholar
  47. 47.
    Fang JC, Hilden K, Holubkov R, DiSario JA. Transnasal endoscopy vs. fluoroscopy for the placement of nasoenteric feeding tubes in critically ill patients. Gastrointest Endosc. 2005;62(5):661–6.PubMedCrossRefGoogle Scholar
  48. 48.
    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(4):506–10.PubMedCrossRefGoogle Scholar
  49. 49.
    Lin CH, Liu NJ, Lee CS, et al. Nasogastric feeding tube placement in patients with esophageal cancer: application of ultrathin transnasal endoscopy. Gastrointest Endosc. 2006;64(1):104–7.PubMedCrossRefGoogle Scholar
  50. 50.
    Mahadeva S, Malik A, Hilmi I, Qua CS, Wong CH, Goh KL. Transnasal endoscopic placement of nasoenteric feeding tubes: outcomes and limitations in non-critically ill patients. Nutr Clin Pract. 2008;23(2):176–81.PubMedCrossRefGoogle Scholar
  51. 51.
    Mitchell RG, Kerr RM, Ott DJ, Chen M. Transnasal endoscopic technique for feeding tube placement. Gastrointest Endosc. 1992;38(5):596–7.PubMedCrossRefGoogle Scholar
  52. 52.
    Sato R, Watari J, Tanabe H, et al. Transnasal ultrathin endoscopy for placement of a long intestinal tube in patients with intestinal obstruction. Gastrointest Endosc. 2008;67(6):953–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Wildi SM, Gubler C, Vavricka SR, Fried M, Bauerfeind P. Transnasal endoscopy for the placement of nasoenteral feeding tubes: does the working length of the endoscope matter? Gastrointest Endosc. 2007;66(2):225–9.PubMedCrossRefGoogle Scholar
  54. 54.
    O’Keefe SJ, Foody W, Gill S. Transnasal endoscopic placement of feeding tubes in the intensive care unit. JPEN J Parenter Enteral Nutr. 2003;27(5):349–54.PubMedCrossRefGoogle Scholar
  55. 55.
    Vitale MA, Villotti G, D’Alba L, De Cesare MA, Frontespezi S, Iacopini G. Unsedated transnasal percutaneous endoscopic gastrostomy placement in selected patients. Endoscopy. 2005;37(1):48–51.PubMedCrossRefGoogle Scholar
  56. 56.
    Cappell MS. Risk factors and risk reduction of malignant seeding of the percutaneous endoscopic gastrostomy track from pharyngoesophageal malignancy: a review of all 44 known reported cases. Am J Gastroenterol. 2007;102(6):1307–11.PubMedCrossRefGoogle Scholar
  57. 57.
    Itoi T, Kawai T, Sofuni A, et al. Efficacy and safety of 1-step transnasal endoscopic nasobiliary drainage for the treatment of acute cholangitis in patients with previous endoscopic sphincterotomy (with videos). Gastrointest Endosc. 2008;68(1):84–90.PubMedCrossRefGoogle Scholar
  58. 58.
    Mori A, Ohashi N, Maruyama T, et al. Transnasal endoscopic retrograde chalangiopancreatography using an ultrathin endoscope: a prospective comparison with a routine oral procedure. World J Gastroenterol. 2008;14(10):1514–20.PubMedCrossRefPubMedCentralGoogle Scholar
  59. 59.
    Postma GN, Cohen JT, Belafsky PC, et al. Transnasal esophagoscopy: revisited (over 700 consecutive cases). Laryngoscope. 2005;115(2):321–3.PubMedCrossRefGoogle Scholar
  60. 60.
    Ash-Bernal R, Wise R, Wright SM. Acquired methemoglobinemia: a retrospective series of 138 cases at 2 teaching hospitals. Medicine (Baltimore). 2004;83(5):265–73.CrossRefGoogle Scholar
  61. 61.
    Kane GC, Hoehn SM, Behrenbeck TR, Mulvagh SL. Benzocaine-induced methemoglobinemia based on the Mayo Clinic experience from 28 478 transesophageal echocardiograms: incidence, outcomes, and predisposing factors. Arch Intern Med. 2007;167(18):1977–82.PubMedCrossRefGoogle Scholar
  62. 62.
    Guay J. Methemoglobinemia related to local anesthetics: a summary of 242 episodes. Anesth Analg. 2009;108(3):837–45.PubMedCrossRefGoogle Scholar
  63. 63.
    Bampton PA, Reid DP, Johnson RD, Fitch RJ, Dent J. A comparison of transnasal and transoral oesophagogastroduodenoscopy. J Gastroenterol Hepatol. 1998;13(6):579–84.PubMedCrossRefGoogle Scholar
  64. 64.
    Garcia RT, Cello JP, Nguyen MH, et al. Unsedated ultrathin EGD is well accepted when compared with conventional sedated EGD: a multicenter randomized trial. Gastroenterology. 2003;125(6):1606–12.PubMedCrossRefGoogle Scholar
  65. 65.
    Gorelick AB, Inadomi JM, Barnett JL. Unsedated small-caliber esophagogastroduodenoscopy (EGD): less expensive and less ­time-consuming than conventional EGD. J Clin Gastroenterol. 2001;33(3):210–4.PubMedCrossRefGoogle Scholar
  66. 66.
    Peery AF, Hoppo T, Garman KS, et al. Feasibility, safety, acceptability, and yield of office-based, screening transnasal esophagoscopy (with video). Gastrointest Endosc. 2012;75(5):945–53.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of SurgeryInstitute for the Treatment of Esohageal & Thoracic Disease, West Penn Allegheny Health SystemPittsbrughUSA

Personalised recommendations