TRANS-NASAL OESOPHAGOGASTRODUODENOSCOPY (OGD): CHALLENGING THE STATUS QUO - A DISTRICT GENERAL HOSPITAL CASE SERIES

ABSTRACT

Introduction Oesophagogastroduodenoscopy (OGD) is commonly performed and trans-oral OGD is a very safe procedure. However, it requires nursing support, patient sedation, a dedicated endoscopy suite, and is disliked by patients. The national census by the Joint Advisory Group on Gastrointestinal Endoscopy reported 860,000 OGDs were performed across the UK in a calendar year. of these, only 26,685 were trans-nasal despite having a similarly low risk profile and being preferred by patients. We compared comfort score, sedation, and safety to show trans-nasal OGD is a feasible alternative to trans-oral OGD reducing nursing burden, avoiding endoscopy suites, and reducing procedure length. Methods A single centre retrospective analysis was performed comparing all OGDs performed by a single endoscopist at Whipps Cross and Mile End Hospitals between 01/06/2021 and 24/11/2021. Demographic data, route of entry, indication, comfort score (scale of 0-3), sedation agent and dose, and any complications were recorded for each procedure. The data sets were compared using paired t-test for statistical significance. Results There was 110 OGDs performed (table 1);73 transoral (66%) and 37 trans-nasal (34%). of those trans-nasal OGD 18 (49%) were completed seated. The trans-nasal route had mean comfort score of 0.29 compared with 0.85 for trans-oral route (p = 0.001). There was no statistical difference in xylocaine application with either route. The mean dose of both fentanyl and midazolam was statistically higher in the trans-oral route compared with trans-nasal (p = 0.0001). There were only two complications reported in the cases reviewed. Conclusions Trans-nasal OGD caused significantly less discomfort than trans-oral OGD and required significantly less sedation, and almost half of patients undergoing trans-nasal OGD were able to tolerate the procedure in a seated position. This has advantages for patient safety, as the risk of aspiration is greatly reduced, but is also much less resource intensive. Given the current pressure on endoscopy services nationwide, amplified by COVID-19, trans-nasal endoscopy is safe, less resource intensive, and can be performed outside of a dedicated endoscopy suite. This may be a useful tool in alleviating waiting list pressure and should be discussed with patients and service leads.