Transnasal Esophagoscopy: A Viable Alternative to Conventional Procedures

TNE also requires very little preparation from patients. Generally, they should not eat for three hours beforehand, said Dr. Aviv. If their stomach is full, they will likely regurgitate, making it difficult for physicians to see during the TNE, he explained.

Physicians should also ask that patients forgo blood thinners to avoid bleeding problems during the procedure, said Dr. Aviv. Dr. Postma, however, noted that this is not done at MCG.

Disadvantages

TNE is more of a screening and diagnostic modality than a treatment tool, explained Dr. Anderson. Patients may sometimes need follow-up surgery or a conventional esophagoscopy, he added. Dr. Postma noted, however, that needing CE after TNE is not very common.

One drawback of TNE is that it requires using a small scope, which limits the types of interventions that can be performed, said Dr. Anderson. TNE results in a smaller working channel and results in less control of foreign bodies, especially when compared with rigid esophagoscopy, he observed. If a patient undergoes sedated CE, physicians are able to use balloons through the endoscope to open any strictures they find, he said.

Although many therapeutic instruments are designed to fit through larger side channels, which are only available on standard CE systems, Dr. Postma and his colleagues often perform dilations with a balloon alongside the TNE scope.

Moreover, if significant time is required to perform a procedure, the physician may prefer to sedate the patient and use CE, he continued.

Overall, TNE has undergone a standard pattern of use, Dr. Anderson said. Early adopters find a new technology that they are excited about, and an increasing number of people use it; however, limitations soon become apparent and the enthusiasm fades, he explained. It’s a great tool, but it’s a diagnostic tool, and there are limits to what we can do with it, he concluded.

Recent Data on TNE Indications

Researchers have been evaluating the role of TNE in gastroenterology and otolaryngology, and have found the technology to be useful for a number of indications. Dr. Postma noted that all studies have found TNE and CE to be equal in diagnostic accuracy, and that patients prefer TNE to CE. Some of the more recent data follow.

Dr. Postma and his colleagues evaluated 711 consecutive cases undergoing TNE (Laryngoscope 2005;115(2):321-3) and found that the most frequent indications were esophageal reflux, globus, or dysphagia (n = 490), biopsy of the laryngopharynx, trachea, or esophagus (n = 42), screening of the esophagus in head and neck cancer (n = 45), and evaluation for an esophageal foreign body (n = 12). A tight nasal vault resulted in the inability to enter the esophagus in 17 procedures.