Patients’ perception of transnasal gastroscopy

Introduction: Gastroscopy is an excellent technique for investigation of upper gastrointestinal pathology. However, patients frequently request for conscious sedation as the procedure causes pain, pharyngeal reflex and nausea. Administration of conscious sedation incurs additional medical expenditure and risks. Transnasal gastroscopy, which became commercially available in 2005, does not induce pharyngeal reflex. The aim of this study was to examine patients’ perception and satisfaction with transnasal gastroscopy performed in an office setting. Methods: Questionnaires were administered to consecutive patients after the performance of transnasal gastroscopy. Patients received topical ten percent xylocaine spray to the nasal and pharyngeal cavities 1-2 minutes before the procedure. The transnasal endoscope used was a narrow upper gastrointest inal endoscope (EG270N5 [Fujinon, Saitama City, Japan]). Results: Transnasal gastroscopy was attempted in 96 patients. The procedure failed in one patient due to a narrow nasal passage and had to be converted to oral route of intubation. Questionnaires were completed by 96 patients. There were 52 males (54 percent) with the median age of 43 (range 11-85) years. None of them received conscious sedation. 53 patients (56 percent) reported that there was no pain/discomfort during the procedure. On the Lickert visual analogue scale for pain from 0 to 10 points, 91 patients (96 percent) reported severity of pain of below 5 points. 85 patients (89 percent) reported they were satisfied or more than satisfied with the procedure. 84 patients (88 percent) were happy to undergo similar repeat procedure without sedation. 25 patients (26 percent) had undergone previous oral gastroscopy; 22 of these patients reported that transnasal route was definitely more comfortable than the oral route. There were two incidents of nosebleed which were self-limiting. Conclusion: Transnasal gastroscopy with a thin endoscope was found to be safe. The procedure is well-tolerated by patients without conscious sedation. Patients reported better preference for transnasal endoscopes in comparison to conventional transoral gastroscopy.