Study Explores Advantages of Pediatric Unsedated Transnasal Endoscopy

Research study background 

The Digestive Health Institute at Children’s Hospital Colorado was the first to offer pediatric unsedated transnasal esophagoscopy (TNE) in the United States and performs the highest volume of these less invasive procedures to diagnose and monitor a variety of gastrointestinal conditions. 

Compared to standard pediatric esophagogastroduodenoscopy (EGD), also called upper intestinal endoscopy, that is performed under general anesthesia, unsedated TNE offers several potential advantages. The endoscope used in TNE is a smaller diameter yet yields comparable diagnostic results to EGD. Additionally, TNE eliminates anesthesia-associated risks and the need for an anesthesiologist as it is sedation free. It reduces recovery and total visit time, and overall, it’s less costly than EGD. Individuals with conditions like eosinophilic esophagitis (EoE) who require frequent esophageal surveillance may especially benefit from this approach. 

Additionally, TNE has a robust safety profile, documented in the team’s previous studies as minor intra-procedural adverse events (such as vomiting, epistaxis, nausea, and tracheal intubation after sneezing). In contrast, their research on adverse events after EGD reported a low, yet clinically significant, rate of complications that required additional medical care.  

This study is the first and largest to evaluate and compare the two techniques for the number and severity of post-procedural adverse events. The cohort included all patients between 5 and 22 years old who underwent outpatient TNEs or diagnostic EGDs at Children’s Colorado (except those who underwent additional therapeutic endoscopic procedures) between January 2015 and June 2022.  

The overall adverse event rate, while rare, was significantly higher for EGD than TNE. There were 196 adverse events (from Grade I-IV) recorded from 10,023 diagnostic EGDs. The most common adverse events after EGD were fever, abdominal pain, chest pain, throat pain and vomiting. In addition, 11 patients experienced an anesthesia-related adverse event. There was only one adverse event recorded, fever, from 927 TNEs. 

The total post-procedure adverse event rate for all indications was 1.96% for EGD and 0.11% for TNE. The post-procedure rate of clinically significant adverse events (Grade II severity or higher requiring medical care) was 0.67% for EGD and 0% for TNE. EoE evaluations made up 93% of all TNEs performed and 16% of EGDs. When researchers controlled for EoE as the procedure indication, adverse event rates were similar to the overall cohort. When researchers adjusted for confounding variables of age, sex and the American Society of Anesthesiologists’ definitions for patient class, adverse event rates remained significantly lower for TNE compared to EGD.  

Relevance to practice 

Results from this study demonstrate that unsedated TNE offers a safer outpatient approach than sedated EGD for monitoring esophageal pathology in appropriately selected pediatric patients.