Is the Transnasal Access for Esophagogastroduodenoscopy in Routine Use Equal to the Transoral Route? A Prospective, Randomized Trial

Abstract

Background and Study Aims: Routine esophagogastroduodenoscopy (EGD) is increasingly performed without sedation. Transoral (TO) and transnasal (TN) EGD offer different patient comfort and complications.

Patients and Methods: For a controlled, randomized, clinical trial comparing TN-EGD with TO-EGD without sedation, patients were assigned to TN-EGD using a thin endoscope (group 1, 93 patients), or TO-EGD using a standard endoscope (group 2, 90 patients). Physician-rated procedural time and complications as well as patient-rated side effects and preferences were compared. In group 3, patients (118) who had previously undergone TO-EGD, now underwent TN-EGD.

Results: Between group 1 and 2 there was no significant difference for procedural time. Nausea (p = 0.047) and epistaxis (p < 0.001) were significantly more frequent for TN-EGD. Conversion rate from TN- to TO-EGD was low with 4.3 %. For TN-EGD, patients’ tolerance was better (p < 0.001), gagging was less (p < 0.001). In case of a future EGD, patients who know both procedures (group 3), strongly vote for TN-EGD (80 %). All groups vote against sedation for future procedures (90 %/90 %/89 %).

Conclusions: Epistaxis can be relevant after TN-EGD, but can mostly be managed conservatively. TN-EGD is superior to TO-EGD regarding subjective and objective gagging as well as procedural tolerance. Patients who experienced both access routes, prefer TN-EGD. TN-EGD without sedation should be aspired for patient comfort and is recommended for routine use.

Zusammenfassung

Hintergrund: Elektive Ösophagogastroduodenoskopien (EGD) werden oft ohne Sedierung durchgeführt. Transorale (TO) und transnasale (TN) EGD haben unterschiedlichen Patientenkomfort und Komplikationen.

Patienten und Methoden: In einer kontrollierten, randomisierten, klinischen Studie wurde die TN-EGD mit der TO-EGD ohne Sedierung verglichen, und zwar Gruppe 1 (93 Patienten, TN-EGD mit dünnem Endoskop) mit Gruppe 2 (90 Patienten, TO-EGD mit Standardendoskop). Gruppe 3 (Kontrolle) enthielt 118 Patienten, die früher eine TO-EGD hatten und nun eine TN-EGD bekamen. Arztbewertete Untersuchungszeit und Komplikationen sowie patientenbewertete Nebenwirkungen und Vorlieben wurden verglichen.

Ergebnisse: Zwischen Gruppe 1 und 2 gab es keinen signifikanten Unterschied in der Untersuchungszeit. Übelkeit (p = 0,047) und Epistaxis (p < 0,001) waren signifikant häufiger bei der TN-EGD. Die Konversionsrate von TN- zu TO-EGD war mit 4.3 % niedrig. Die TN-EGD wurde besser toleriert (p < 0,001), der Würgereiz war geringer (p < 0,001). Für eine erneute EGD bevorzugen Patienten, die beide Techniken kennen (Gruppe 3), die TN-EGD (80 %). Alle Gruppen wünschen für zukünftige Untersuchungen keine Sedierung (90 %/90 %/89 %).

Resultate: Epistaxis nach einer TN-EGD kann meist konservativ behandelt werden. Die TN-EGD ist der TO-EGD überlegen in Bezug auf Würgereiz und Akzeptanz der Untersuchung. Patienten, die beide Methoden kennen, bevorzugen die TN-EGD. Die TN-EGD ohne Sedierung wird für den Patientenkomfort empfohlen.

Schlüsselwörter

Ösophagus - Magen - Darm - transoraler Zugang - transnasal - oberer GI-Trakt

Key words

esophagus - stomach - bowel - transoral access - transnasal access - upper GI tract

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