Cardiovascular tolerance in unsedated upper gastrointestinal endoscopy: Prospective randomized comparison between transnasal and conventional oral procedures

Background: The utility of transnasal esophagogastroduodenoscopy (EGD) using ultrathin endoscopy has previously been described by analyzing subjective information and comparing it to conventional oral EGD. Limited information is available regarding the advantageous use of nasal EGD when assessed by reliable objective data. Methods: A total of 927 patients undergoing unsedated EGD between June 2004 and May 2005 were enrolled. We used a partially randomized patient-centered study design in order to exclude a bias of the patient's preference. Patients were divided into four groups. Patients who preferred oral or nasal EGD underwent endoscopy according to their preference (preferred group). Patients without preference were randomly assigned to oral and nasal EGD (randomized group). Pulse, blood pressure (BP) and peripheral blood oxygen saturation (SpO₂) were monitored during the procedure. Acceptability of EGD was also assessed by an acceptance score and the rate of willingness to repeat the same procedure. Results: Oral and nasal EGD were performed in 325 and 387 patients, respectively, in the preferred group, and 81 and 77 cases, respectively, in the randomized group. Nasal EGD was incomplete in 57 patients. Increases in BP were significantly lower in nasal EGD than in oral endoscopy in both the randomized and preferred groups, whereas no significant difference was found in the increment of pulse between the groups. Changes in SpO₂ were minimal in either procedure. Analyses of patient acceptability showed favorable evaluation of nasal EGD in both randomized and preferred groups. Conclusions: Nasal EGD appears to be less stressful to the cardiovascular system. Patient's acceptability also supports its usefulness unless difficulties in transnasal insertion are encountered.