Let your patients watch and talk during examination: A review of unsedated transnasal endoscopy

The use of unsedated transnasal esophagogastroduodenoscopy (UT-EGD) is a milestone in gastrointestinal endoscopy. Although the image quality, suction, air insufflation, and lens washing in UT-EGD have been reported to be inferior to those in conventional peroral EGD (P-EGD), the former procedure is associated with reduced gag reflex and is better tolerated than the latter. Several large studies have shown that transnasal endoscopy is safe, well tolerated, and less risky than P-EGD, which requires sedation in most western countries. Moreover, UT-EGD induces less sympathetic stimulation and less oxygen desaturation compared with P-EGD. Use of an ultrathin endoscopy, an alternative choice to endoscopic retrograde cholangiography, is helpful in patients with gastrointestinal stenosis and is a convenient method for postpyloric feeding tube placement. However, nasal anesthetic methods, techniques of scope insertion and withdrawal from the delicate nasal cavity, and therapeutic applications may be difficult to learn without proper training, even for an experienced endoscopist.