LAUSR

Introduction Per oral endoscopy can be uncomfortable and distressing leading many patients to opt for conscious sedation over topical local anaesthetic. Transnasal endoscopy is better tolerated with lower cardiovascular stress response. We sought to assess how easily TNE might be introduced to a District General Hospital and how acceptable patients found it. Methods Patients requiring endoscopy were considered for TNE using 5.8mm diameter Fujinon EG580NW2 scopes using topical nasal anaesthetic. Those with significant comorbidities, increased risk of bleeding and likely to need therapeutic intervention were excluded. Two consultants, with considerable OGD but minimal TNE experience, scoped consecutive patients from the outset of TNE introduction locally. Patients were sent postal feedback questionnaires including visual analogue scales (VAS 1 to 10) to assess comfort, distress, recollection of the peri-procedural consultation and overall experience. Results 213 TNE procedures were performed by the consultants (87%) and two senior trainees. For 6 patients (2.8%) the scope could not be navigated through the nasal passages and endoscopy was completed, using the same scope, per oral. Two patients (0.9%) had self-limiting epistaxsis and no patient required admission. 100 questionnaires (46.9%) were returned. 61.1% of patients found their TNE procedure comfortable (VAS >6) with 17.9% describing discomfort (VAS <5) (21.0% ambivalent, VAS –). 72.9% did not find it a distressing procedure (VAS <5) whilst only 17.8% did (VAS >6), (9.4% ambivalent, VAS –). 88.4% had a clear recollection of their consultation (VAS>6) with only 9% reporting poor recollection (VAS <5), (5% ambivalent, VAS –). Overall satisfaction was reported as good (VAS >6) by 94.7% of patients and poor (VAS <5) by only 5.3%. Of our 213 patients, 33 had previous OGD experience with 28 (84.8%) expressing preference for TNE. Our endoscopy database held reports for 18 of these showing 11 had Xylocaine spray and 7 intravenous Midazolam. Of the four patients that preferred OGD, 2 had had Xylocine and 2 Midazolam. Conclusions TNE can be adopted by clinicians competent with conventional OGD with expectation of high procedure completion rate and low complication rate. Our findings suggest that our patients prefer TNE to conventional OGD, with or without sedation. Most patients found TNE comfortable with few reporting distress, maybe as a consequence, most patients had a clear recollection of their consultation.