THE TRANSNASAL ESOPHAGOSCOPY

The transnasal esophagoscopy (TNE in English) (also known as transnasal esophagogastroduodenoscopy) is an endoscopic replacement, and similar to traditional endoscopy. The TNE is also used as a screening technique for cancer of the esophagus and other problems such as difficulty swallowing, painful swallowing, acid reflux or chronic cough. Initially assets of otolaryngologists, in recent years its use has extended to other categories of specialists. The internists may use the TNE in suspicion of Barrett's esophagus. Through a case study performed on thousands of patients, the reliability of the 'examination TNE is comparable to that of traditional gastroscopy as well as the ability to perform biopsies. The recent developments in technology have made it possible to overcome most of the problems of inconsistency between the results of TNE and those of the biopsy, present in some cases of the past. The trans-nasal esophagoscopy, however, requires further evaluation before it can be adopted as a screening technique for the diagnosis of Barrett's esophagus. According to many authors the TNE could now replace the X-rays of the esophagus with barium swallow in patients with gastroesophageal reflux, dysphagia and suspected esophageal foreign body.
The nasal cavities must be properly anesthetized to allow the passage of the hose transnasal endoscope, the diameter of which, depending on the manufacturer, varies from 4.0 to just over 6.0 mm. On the contrary it is good to proceed only to a slight anesthesia of the laryngopharynx, because during this examination shall know that the patient is able to swallow on command. Moreover, an excessive pharyngolaryngeal anesthesia puts the patient at risk for aspiration of its secretions during the examination. The nasal cavity of the patient is sprayed with spray 1:1 oxymetazoline 0.05% and lidocaine 4%. A few splashes of benzocaine 20% can be administered into the oropharynx. Once completed under local anesthesia, the TNE endoscope is passed through the nose until all'ipofaringe. The patient is asked to swallow and at the same time the endoscope is pushed into the pyriform sinus and, from there, into the esophagus and then in the proximal part of the stomach.

It is essential, in the course of gastroscopy TNE, register the examination, in both analog and with digital recording devices. Reviewing the examination using slow motion and still picture, in fact, very useful to observe the opening Cricopharyngeal in esophagus to exclude neoplasms, as well as to study the anatomy of the esophagogastric junction (which, once in the stomach, is obtained flexing tip completely, that is, about 210 degrees) and exclude Barrett's esophagus.

There are different types of gastroscopes pernasal. All are characterized by being ultra-thin, 4.0 to 6.0 mm. Among the most popular there is a video chip distal transnasal endoscopic system in which the camera is positioned in the vicinity of the tip of the endoscope. Such systems with video chip distal generally present of internal channels so that they can take place through the air insufflation and water and the biopsy. However often the operating channel is only 2 mm (against about 3 mm of normal gastroscope) and, therefore, the biopsy will be necessarily smaller, as carried out with a thinner caliper.

Most of the complications that occur in the course of an endoscopy are related to the sedation of the patient. Hypoventilation, aspiration and airway obstruction, respiratory complications represent the most relevant. One of the most dreaded complications, although rare, is the esophageal perforation. Although there are now thousands of TNE gastroscopy performed in the world, it was reported a single case of esophageal perforation.

Just because of their reduced diameter gastroscopes pernasal allow cross sections stenotic otherwise insurmountable with the traditional gastroscope. And thanks to the smaller sensor, the patient suffers less of the classic problems related to endoscopy (choking, nausea, tightness, and others). The passage through the nose is typically little or no annoying and the test result is better surmountable by the patient.

The gastroscopy TNE would have lower direct cost to traditional gastroscopy, especially in relation to the procedure shorter and lower costs associated with the shortest time of awakening and recovery, as well as lower costs related to medication and monitoring. Would also lower indirect costs, including the hours of work lost both the patient and by the accompanying: TNE gastroscopy after the majority of patients are able to return home or to work immediately after the completion of the examination and does not require an assistant accompanist