Prospective Comparison of Nasal Versus Oral Insertion of a Thin Video Endoscope in Healthy Volunteers

Abstract

Background and Study Aims: Attempts have been made to improve patients' tolerance of upper gastrointestinal endoscopy and to decrease the need for sedation, using thinner endoscopes and a nasal introduction route. We prospectively compared the oral and nasal routes in volunteers, using a thin prototype video endoscope.

Methods: Ten healthy volunteers underwent two upper gastrointestinal endoscopies in a random order on two different days, with the procedure being carried out by a single experienced endoscopist. Parameters assessed were the tolerance of scope insertion and the assessment of the entire procedure (0-10 scale), the method of insertion preferred by the volunteers, the completeness of the examination (assessed by an independent endoscopist), and the time required for the procedure.

Results: In one patient, nasal insertion failed, and she was excluded from further analysis. The insertion of the scope was easier via the oral route, as reflected in a shorter examination time (mean 165 vs. 210 seconds, p = 0.017) and patients' tolerance for the scope insertion (mean score: 8 for oral vs. 4 for nasal route; p = 0.03). On the other hand, gagging occurred more frequently during oral endoscopy (6/9 vs 1/9, p = 0.05). Three of the volunteers in each case preferred the oral or the nasal route, and three were not decided, in case of a repeated endoscopy. Similarly, the overall tolerance for the procedure did not differ between the two groups.

Conclusion: Thin-diameter gastroscopes seem to improve patients' tolerance. In this small study in volunteers, nasal introduction showed no overall benefit over oral introduction. Modifications of the scope to achieve better nasal passage are necessary.