A new study reports that unsedated transnasal endoscopy (TNE) is a feasible, safe, and well-tolerated method to screen for esophageal disease in a primary care population.

Researchers at the University of Pittsburgh Medical Center (UPMC; PA, USA) and the University of North Carolina (Chapel Hill, USA) conducted a multicenter, prospective, cross-sectional study involving 426 participants (aged 40-85 years) to assess the feasibility, safety, acceptability, and yield of unsedated TNE. Main outcome measures included procedure yield, completeness of examination, procedure length, adverse events and complications, and overall tolerability.

The results showed that mean examination time was 3.7 minutes. There were no serious adverse events, and only 12 participants reported minor complications. The examination was well tolerated by most participants, who reported minimal choking, gagging, pain, or anxiety. Overall, 38% of participants had an esophageal finding that changed management (34% erosive esophagitis, 4% Barrett's esophagus), with the majority reported reflux or heartburn symptoms. The study was published in the May 2012 issue of Gastrointestinal Endoscopy.

“Unsedated transnasal endoscopy is both feasible and safe in a primary care population, achieving short procedure times, a high diagnostic yield, and minimal anxiety,” concluded study coauthor Blair Jobe, MD, of UPMC, and colleagues. “Patients reported good acceptability and minimal discomfort. These results suggest that we can now lower the threshold for endoscopic esophageal screening and with less cost.”

TNE uses ultrathin endoscopes that are passed through the patient's nose into the esophagus for performance of an upper endoscopy; typically, the examination is carried out at least to the level of the proximal-to-mid stomach, depending on the height of the patient. Often, TNE can be performed without sedation through the use of topical anesthetics sprayed into the patient's nose and/or mouth. Avoiding intravenous sedation allows patients to drive following the examination, and eliminates the need for a second person to accompany the patient.

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