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N Arya, K Swan, G Monkewich, SJ Tang, SA Zanati, M Cirocco, NE Marcon

Department of Gastroenterology, Therapeutic Endoscopy, St Michael’s Hospital, Toronto, Ontario

INTRODUCTION: With increasing costs of health care and limited hospital budgets, endoscopists must amalgamate the budgetary constraints with appropriate evaluation of patients. Transnasal endoscopy (TE) has advantages of no sedation, less patient monitoring, less nursing time and less expense than conventional peroral esophagogastroduodenoscopy (EGD). This study assessed the feasibility, complication rate and patient tolerance of TE.

METHODS: A retrospective analysis reviewed patient’s age, sex, and indication for procedure, outcome of procedure and complication rate. All patients were survey using a patient satisfaction questionnaire, assessing acceptability, choking sensation, sore throat, nasal discomfort, abdominal discomfort. All variables were assessed between 0 and 10, 10 being highly acceptable, highest degree of choking, sore throat, nasal discomfort and abdominal discomfort.

RESULTS: Between March 2002 and August 2003, 231 patients had transnasal endoscopy in the office by an experienced gastroenterologist. The average age of the patients was 57 years old (range 15 to 87 years old), 43% being female (100 patients). The indications for the procedure were dyspepsia (115 patients); reflux symptoms (52 patients); anemia (36 patients); dysphagia (10 patients); nausea and vomiting (4 patients); post-surgical screening (2 patients); radiological abnormality (3 patients), family history of gastric cancer (5 patients); weight loss (3 patients) and 1 patient for post-polypectomy evaluation.

Of the 231 patients, 5 patients were unable to complete the procedure due to narrow nasal passage (success rate of 98%). Patients reported a high degree of acceptability (6.6), and low degrees of: choking sensation (1.8); nasal discomfort (1.7); sore throat (0.9); and abdominal discomfort (1.1). The complications reported by patients were transient light headedness (12 patients); nose bleed (2 patients); sinusitis (1 patient); mucus discharge (2 patients) and nasal discomfort (3 patients). When asked, 88% of patients would have the procedure again.

CONCLUSION: Transnasal endoscopy was tolerated and acceptable in the majority of patient. The low complication rate and high patient satisfaction makes transnasal endoscopy an acceptable alternative in our constrained health care system.

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