Abstract
Background and study aims Screening for esophageal and gastric varices is indicated for patients with portal
hypertension or cirrhosis. Typically, conventional endoscopy is used; however, the
need for sedation increases the costs and risks, especially in cirrhotic patients.
Use of transnasal endoscopy with an ultrathin endoscope enables study of the upper
gastrointestinal tract without the need for sedation. The objective of this study
is to evaluate the feasibility of transnasal endoscopy in screening for esophageal
and gastric varices in patients with chronic liver disease.
Patients and methods This was a prospective study in which transnasal endoscopy was carried out in patients
with cirrhosis or portal hypertension who had indications for screening of esophageal
and gastric varices. The following variables were evaluated: demographical data, duration
of procedure, patient tolerance and acceptance, adverse events (AEs), endoscopic findings
and interobserver agreement related to portal hypertension alterations (kappa index).
Results A total of 50 patients entered the study. The most common cause of liver disease was
chronic viral hepatitis (66 %). Among the cirrhotic patients, most of the patients
were Child-Pugh A (74 %). In 5 patients (10 %), nasal intubation was not possible.
Two patients (4 %) experienced minor epistaxis. Tolerance was excellent or good in
92 % according with a visual analogic scale. In 16 patients (32 %), esophageal varices
were detected and in 2 patients (4 %) gastric varices were detected. The mean duration
of the procedure was 7 minutes.
Conclusions Transnasal endoscopy is feasible, effective and well tolerated for screening of esophageal
and gastric varices in patients with chronic liver disease. It can be performed in
outpatient clinics safely and without the use of sedation.
