Unsedated transnasal upper gastrointestinal endoscopy has favorable diagnostic effectiveness, cardiopulmonary safety, and patient satisfaction compared with conventional or sedated endoscopy.

ABSTRACT

BACKGROUND: To assess the diagnostic effectiveness, cardiopulmonary safety, and patient comfort of transnasal endoscopy (TNE), compared with conventional endoscopy (CES) and sedated endoscopy (SES), and to compare procedural risks and patient satisfaction/preference. METHODS: In this prospective, randomized, and controlled protocol, eligible patients (n = 397) in an outpatient clinic were randomized to CES (n = 133), SES (n = 134), or unsedated TNE (n = 130) due to upper gastrointestinal (GI) complaints. Patients were continuously monitored for systolic/diastolic blood pressure (SBP/DBP), pulse rate (PR), and SpO(2) throughout the endoscopy. All subjects (n = 392) completing their assigned endoscopy were asked to evaluate endoscopy satisfaction, pain, and nausea/vomiting on visual analog scales. Patient preference for the assigned endoscopy was assessed against previous endoscopy experience or by willingness to repeat the assigned endoscopy. RESULTS: Endoscopic outcomes for the esophagus, stomach, and duodenum were comparable among the three groups. SBP/DBP and PR were more stable in patients undergoing TNE than in those undergoing CES or SES, while SpO(2) remained stable and above 95% among all three groups. Patients were more satisfied with TNE than with CES and experienced less pain and nausea/vomiting. Patients exhibited a high preference for SES, whereas 67.6% of patients who previously underwent SES and were randomly assigned to TNE were willing to undergo TNE again. CONCLUSIONS: TNE has comparable diagnostic effectiveness to CES and SES, but is less stressful on cardiopulmonary function, indicating that TNE is a more comfortable, preferred, and cost-effective endoscopic technique than CES and SES.