Transnasal Endoscopy: A Patient-Friendly Alternative to Traditional Gastroscopy

Transnasal endoscopy (TNE) is an innovative alternative to traditional gastroscopy that's gaining popularity across UK hospitals. This minimally invasive procedure uses an ultra-thin endoscope inserted through the nose rather than the mouth to examine your upper digestive tract, including the esophagus, stomach, and duodenum.

If you're experiencing symptoms such as persistent heartburn, difficulty swallowing, or unexplained digestive discomfort, your doctor might recommend an endoscopic examination. Understanding your options, including TNE, can help you make informed decisions about your diagnostic journey and potentially experience a more comfortable procedure.

Transnasal endoscopy involves passing a very thin flexible tube (typically 5-6mm in diameter) through the nose and down into the digestive tract. This contrasts with traditional gastroscopy, which uses a thicker tube (around 9-10mm) inserted through the mouth.

The key difference lies in the approach and the size of the endoscope:

• Traditional gastroscopy: Uses a larger endoscope through the mouth, often triggering gagging reflexes
• Transnasal endoscopy: Uses an ultra-thin endoscope through the nose, bypassing the gag reflex

The procedure typically takes just 5-10 minutes to complete, though your total time in the endoscopy department will be longer due to preparation and recovery.

Transnasal endoscopy offers several significant advantages over traditional oral gastroscopy:

No Sedation Required

One of the most notable benefits is that TNE can typically be performed without sedation. This means:

• No drowsiness or impaired judgment afterward
• Ability to drive yourself home immediately
• No need for someone to accompany you
• Immediate return to normal activities

Enhanced Patient Comfort

Studies consistently show that patients experience significantly less discomfort with TNE compared to traditional procedures. Research demonstrates that TNE patients report significantly better comfort scores (7.3 vs. 5.3 on visual analog scales) PubMed compared to standard oral endoscopy.

TNE reduces or eliminates:

• Gagging and retching
• Feelings of suffocation
• The need for prolonged fasting

Ability to Communicate During the Procedure

Since your mouth remains free during the examination, you can:

• Speak with your doctor throughout the procedure
• Express any discomfort immediately
• Ask questions in real-time
• Breathe normally through your mouth

Reduced Cardiovascular Stress

The transnasal approach has been shown to cause significantly less cardiovascular stress regardless of the degree of comfort PubMed, making it particularly valuable for patients with existing heart or respiratory conditions.

Cost-Effectiveness

From a healthcare system perspective, TNE is more economical. Studies show that TNE costs approximately 30% less than oral endoscopy PubMed, primarily due to eliminated sedation costs and reduced recovery time requirements.

TNE is particularly suitable for:

• Elderly patients or those with multiple health conditions
• Patients with anxiety about traditional endoscopy
• Those who have had uncomfortable experiences with previous oral endoscopies
• People with heart or breathing conditions
• Busy individuals who need to return to work immediately
• Patients who prefer to avoid sedation

Most patients are good candidates for TNE, but your doctor will assess your suitability based on your medical history and the specific diagnostic requirements.

TNE's availability has been expanding across NHS hospitals and private clinics throughout the UK. A notable example is the Royal United Hospitals Bath NHS Foundation Trust, which implemented a successful TNE service that improved patient satisfaction while reducing costs NHS Supply Chain.

Many NHS hospitals now offer TNE as an alternative to conventional gastroscopy, though waiting times can vary by location. For those considering private options, numerous private healthcare providers now include TNE in their services.

If you're considering private transnasal endoscopy, costs typically range from £1,300 to £2,000, depending on:

• Location (London and major cities tend to be more expensive)
• The specific healthcare provider
• Whether any additional procedures or biopsies are needed
• Follow-up consultations

These costs are generally comparable to or slightly lower than traditional private endoscopy with sedation, reflecting the reduced resource requirements of the procedure.

Preparation for TNE is straightforward:

1. Fast for approximately 6 hours before the procedure (though you can usually take small sips of water up to 2 hours before)
2. Inform your doctor about any medications you're taking
3. No special preparation is needed for your nose, though a decongestant spray will be applied just before the procedure

Unlike traditional gastroscopy with sedation, you won't need to:

• Arrange for someone to accompany you
• Take time off work (beyond the appointment itself)
• Avoid driving or making important decisions afterward

During your TNE appointment:

1. A local anesthetic and decongestant will be sprayed into your nostril
2. The endoscopist will gently pass the ultra-thin tube through your nostril
3. You'll be asked to swallow as the tube passes into your esophagus
4. The endoscopist will examine your upper digestive tract, taking biopsies if necessary
5. The tube will be gently withdrawn
6. You'll receive immediate feedback on findings

Most patients experience only mild discomfort during the procedure, typically described as strange pressure rather than pain.

Transnasal endoscopy represents a significant advancement in diagnostic procedures for upper gastrointestinal conditions. Its combination of enhanced patient comfort, reduced need for sedation, and cost-effectiveness makes it an attractive option for both patients and healthcare providers.

As TNE becomes more widely available across the UK, patients now have a valuable alternative to traditional gastroscopy that maintains diagnostic accuracy while significantly improving the procedural experience. If you require an upper GI endoscopy, discussing the transnasal option with your healthcare provider could lead to a more comfortable diagnostic journey.