Unsedated transnasal laryngo-esophagogastroduodenoscopy: an alternative to conventional endoscopy

The introduction, refinement, and subsequent widespread use of flexible fiberoptic endoscopes have revolutionized the diagnosis and management of upper gastrointestinal (GI) disorders. There has been a simultaneous increase in the cost of managing upper GI disorders, which is in part attributed to the high price of endoscopy. Unfortunately, in the current cost-conscious health-care environment, the high cost of endoscopy has resulted in the underuse of this valuable clinical tool. Unsedated transnasal laryngo-esophagogastroduodenoscopy (T-EGD) is a new technique for upper endoscopy that uses an ultrathin endoscope and has a comparable yield to conventional upper endoscopy but obviates the need for conscious sedation because it is better tolerated. Studies have found that T-EGD is a feasible alternative to conventional endoscopy in terms of safety, efficacy, and cost containment. This article reviews these factors, the technique of T-EGD, patient and endoscopist considerations, tissue sampling, and the characteristics of ultrathin endoscopes used for T-EGD.