Abstract
Background and Study Aims: Gastroscopy is often an unpleasant procedure for the patient. Sedation improves the
tolerance, but it causes inconvenience both for patients and for endoscopy units.
The aim of the present study was to compare the feasibility, safety, and tolerance
of transnasal gastroscopy using a thin endoscope with conventional oral gastroscopy.
Patients and Methods: One hundred eighty-one consecutive outpatients referred for diagnostic gastroscopy
were randomized to undergo transnasal or oral conventional gastroscopy. The tolerance
(discomfort, retching, throat pain, and desire for sedation in any further procedures)
and examination difficulty (intubation, examination, aspiration, and visibility) were
assessed by the patients and the endoscopists, respectively, using visual analogue
scales and a questionnaire.
Results: Endoscope insertion failed in six patients (four transnasal, two conventional). The
tolerance was significantly better with transnasal gastroscopy in comparison to conventional
oral gastroscopy. Only 3 % of patients undergoing transnasal gastroscopy desired sedation
in any further examinations, compared to 15 % in the conventional oral gastroscopy
group (P = 0.01). The examination time was longer in the transnasal group (5 min 25 sec ± 1 min
46 sec vs. 3 min 22 sec ± 1 min 9 sec, P < 0.001). Visualization capability and aspiration using the thin endoscope were considered
more difficult by the endoscopists.
Conclusions: Nasal introduction of thin endoscopes is better tolerated by patients than conventional
gastroscopy, minimizing the need for sedation. However, technical improvements in
thin endoscopes (a wider working channel, increased length and better image quality)
would increase their usefulness.
