Thin transnasal endoscopes (diameter 5 - 6 mm) have been on the market for some time, and have been shown to be better tolerated than endoscopy via the oral route (without sedation) - possibly at the loss of image quality, although this is difficult to quantify. In a multicenter study in France involving 500 patients, the transnasal endoscope was compared with the standard gastroscope introduced transorally, and only a local spray was allowed. The rate of failure to intubate was higher with the transnasal route (6.8 % vs. 1.7 %), and visibility was better with the standard endoscope (significant only for the cardia). The transnasal route was better tolerated by patients (willingness to repeat endoscopy 90 % versus 75 %), although 25 % of patients reported pain in the nostrils [1]. A similar endoscope was used in routine practice in 1327 consecutive outpatients, with a mean examination time of 3.1 min (we had thought that Olympic records in gastroscopy were over) and a completion rate of 95 %, with good patient tolerance [2]. Two groups presented the next step - use of a battery-powered ultrathin endoscope (3 mm in diameter), which is intended only for esophageal examination; its accuracy in detecting disease was substantially inferior to that of standard EGD (sensitivities for various disorders 54 - 84 %) [3]. Another study found that patient acceptance of unsedated esophagoscopy, even with this very thin endoscope, was limited - only 50 % of the 48 patients who underwent both ultrathin and conventional endoscopy stated that they would prefer the thin scope in the future [4]. It remains to be seen whether slim endoscopes will be able to establish themselves, by improving both patient acceptance and image quality.
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