Transnasal Endoscopy Is Not As Simple As You Can Imagine | 53882
Journal of Gastrointestinal & Digestive System
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An ultrathin endoscope was initially developed in the 1970s for the use in pediatric patients. In recent years, unsedated
transnasal esophagogastroduodenoscopy (UT-EGD) has been used for diagnostic and therapeutic purposes such as
percutaneous endoscopic gastrostomy, enteral tube placement, nasobiliary tube drainage and polypectomy. The satisfactory
safety and tolerance profiles make UT-EGD an alternative to peroral conventional EGD with or without sedation. There is a
trend toward performing transnasal laryngoscopy, transnasal esophagoscopy (especially for screening Barrett's esophagus) and
UT-EGD in the office. However, many techniques related to UT-EGD are not standardized. Professor Hu proposed reporting
the how, where, and grading of nasomucosal injury (grade 0, 1, 2 and 3) after transnasal endoscopy. He demonstrated that an
endoscopic-guided method (EGNA) is better than the cotton-tippled applicator method (CTNA) of nasal anesthesia. Further,
he revealed a cotton-tipped applicator primed gauze pledgetting (CTGP) method is more effective than EGNA. CTGP, which
only needs a 5-min procedure, has achieved a painless nasal insertion and exertion. He has recently introduced anterior
meatuscopy coupled with an endoscopic meatus scoring system (EMSS, grade 0, I, II and III), replacing sniff test to select
an optimal meatus insertion route before UT-EGD. Documenting a meatus score is important because it may be correlated
with the severity of nasomucosal injury and bleeding. In addition to the novel nasal anesthetic methodology, the techniques
of endoscopic insertions from the anterior to posterior nasal cavities, nasopharynx to oropharynx, and hypopharynx to the
esophagus will be demonstrated. He will also introduce techniques to avoid nasal bleeding and gag reflex.
Chi-Tan Hu has completed his MD from Taipei Medical University, Taipei, Taiwan and PhD from Cambridge University, UK. He has done his Postdoctoral studies from National Institute of Health, Bethesda, Maryland, USA. He is the Chief of Department of Gastroenterology, Buddhist Tzu Chi Hospital, Hualien, Taiwan. His research interests are on Transnasal Endoscopy, Helicobacter pylori, Irritable Bowel Syndrome and Hepatocellular Carcinoma. He has published more than 100 papers in the international journals.