Is the transnasal access for esophagogastroduodenoscopy in routine use equal to the transoral route? A prospective, randomized trial.

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.

[Uncommon condition of the upper gastrointestinal tract: double pylorus]. / Seltene Befunde am oberen Gastrointestinaltrakt: Der Doppelpylorus.

Double pylorus and gastroduodenal fistula are uncommon conditions that are either congenital or acquired. Acquired double pylorus in most cases resulted from a penetrating peptic ulcer creating a fistula between the duodenal bulb and the prepyloric antrum. The diagnosis is usually made by endoscopy. Surgical intervention should be only considered for patients with refractory symptoms, recurrent ulcers and other complications. We report the case of a 85-year-old man with an acquired duodenal-antral fistula resulting from a retrograde penetration of an ulcus duodeni and simulating a double pylorus.

[Prospective study comparing conventional and transnasal esophagogastroduodenoscopy for routine diagnosis]. / Prospektive Studie zum Vergleich von herkömmlicher und transnasaler Osophago-Gastro-Duodenoskopie in der Routinediagnostik.

INTRODUCTION: Transnasal gastroscopy (TNG) is the result of ongoing improvements in endoscopic device development. These ultrathin endoscopes are planned to improve patient satisfaction with the endoscopic procedure. AIM: The aim of the current study was to prospectively evaluate the performance and patient acceptance of transnasal gastroscopy. PATIENTS AND METHODS: Sixty-three consecutive patients (40 males, 23 females, mean age 58.5 years) referred for routine upper gastrointestinal endoscopy to our tertiary care referral centre were assigned to one of three groups: first time transnasal gastroscopy (group 1, TNG), first time transoral gastroscopy (group 2, TOG) and transnasal gastroscopy after a previous unsedated transoral gastroscopy (group 3). All examinations were performed without intravenous sedation. Patients answered a standardised questionnaire immediately following the examination. RESULTS: The three groups of patients did not differ in age, gender or reason for gastroscopy. Investigations performed using transnasal technique were significantly shorter (TNG 8.9 min and 9.2 min vs. TOG 11.9 min, p = 0.011 and p = 0.026, respectively) than those performed in transoral technique. Nosebleeding, albeit not clinically significant, and the urge to wretch were significantly more common in the transnasal technique group (p > 0.001). Patient acceptance tended to score higher in the transnasal technique groups, however not statistically higher. A greater number of patients from group 3 (TNG after previous TOG) would prefer a repeat exam via the transnasal route. CONCLUSIONS: Transnasal gastroscopy represents a possible alternative to the conventional transoral technique. TNG entails less subjective patient discomfort, and patients experienced in both techniques prefer the transnasal route. Shorter examination times and lack of intravenous sedation result in several benefits: no sedation-related complications, shorter post-procedure observation times, and subsequently shorter time off work for patients.