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TRANSNASAL ESOPHAGOSCOPY - SHIFTING TOWARDS BETTER DIAGNOSTICS

TRANSNASAL ESOPHAGOSCOPY - SHIFTING TOWARDS BETTER DIAGNOSTICS
10 Dec, 2017

Transnasal Esophascopyhttp://www.bestentspecialistindelhi.com/transnasal esophagoscopy

There is a continuous  effort towards achieving diagnostic and therapeutic excellence in the field of medicine. Trans oral Esophagoscopy is age old diagnostic and therapeutic modality but the procedure requires sedation, which is accountable for >50% of the associated complications. Most of the cardiac and pulmonary complications occurring during these procedures can be attributed to sedation which is required for the procedure. Thereby, there is a need for a comprehensive evaluation parameter which can avoid the procedure related complications  but provide a complete solution.

Introducing                                                                                                 

Transnasal Esophagoscopy is a novel diagnostic and therapeutic technique which is done with a thinner endoscope (5.1mm) with a length of 60cm which enables complete evaluation of the larynx and esophagus and evaluates lower esophageal sphincter and stomach.

Due to the small size of the scope it is less likely to distort the anatomical details and contours of the esophagus which has a complex anatomical course.

Procedure 

The procedure is safe, cost effective and patient friendly. Since there is no requirement of sedation, it can be done safely as an outpatient or office based procedure. The patient is comfortably seated in a chair, and after decongesting the nasal cavity with adrenaline/xylocaine and oxy xylometazoline, the scope is navigated through the nose.

Clinical evaluation

As the scope reaches the nasopharynx the clinical evaluation begins by observing the velopharynx, oropharynx, laryngeal inlet, the pyriform fossae and the post cricoid region. The scope is then proceeded into the upper part of esophagus approaching through either of the pyriform fossa.

The mucosa of the esophagus as well as the normal contours of the food pipe is observed. Any change in the mucosa, abnormal growth, constriction is looked for. As we approach the lower esophageal sphincter, the squamo-columellar function is observed. Note is made of reflux esophagitis which can be classified according to LA classification as the scope is progressed beyond the LES. The gastric mucosa is observed along the greater and lesser curvature and lower esophageal sphincter is observed by retro flexion of the scope. Hiatus hernia can also be diagnosed here and Barrett’s esophagus can be assessed and evaluated. Apart from the diagnostic, therapeutic procedures such as biopsy, dilatation, injection, laser applications, Botox injection can accomplished successfully.

Post-procedure

There is no particular post procedure care. The patient is asked to sit in the chair for some time and then can return to his/her work.

There are no known complications of the procedure. The incidence of epistaxis ranges from 0.85-2% and that of vaso vagal episodes is as low as 0.3%.

TNE VS TOE

Transnasal esophagoscopy is found to be consistent with the findings of transoral esophagoscopy.

TNE is better tolerated than TOE, is safe and bring down the cost of the procedure by as much as 36%.

There is also a much less propensity for adverse effects due to TNE because of the fact that sedation is not required for the procedure so the majority of adverse effects can be .Patients who experience both the procedure, prefer TNE over TOE
 

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