Raquel E Redondo, MD1, Blake Movitz, MD2, Rami Lutfi, MD3. 1Anne Arundel Medical Center, 2UIC Metropolitan Group Hospital Residency, 3Presence Saint Joseph Hospital
Background: This paper aims to describe a single-institution experience with unsedated transnasal endoscopy (TNE) as an alternative to conventional peroral esophagogastroduodenoscopy (pEGD) in the evaluation of bariatric patients.
Conventional pEGD involves large-caliber endoscopes and conscious sedation, subjecting high risk morbidly obese patients to possible complications such as airway compromise. Transnasal endoscopy involves use of a small-caliber endoscope in an office setting without need for sedation. Here we describe our TNE experience in a series of 102 patients.
Materials and Methods: All patients undergoing TNE between October 2013 and September 2016 were included in this study. All procedures were performed by a single surgical endoscopist, using a 4.7 x 5.2 mm caliber endoscope without sedation. Prospectively collected data included patient demographics, comorbidities, surgical history, indications, and endoscopic findings. Post-procedurally, patients were offered a survey to rate their experience and select preference (TNE v pEGD). Variables analysed included the completion and adequacy of examination, complications, need for additional evaluation by pEGD, and patient experience and preference.
Results: A total of 102 patients underwent TNE. Mean BMI was 47.7. Indications included primary preoperative evaluation of bariatric patients, evaluation in postoperative bariatric patients for new onset reflux or other complication, and anatomical evaluation of patients being considered for possible revisional bariatric surgery. A small subset of patients not enrolled in the bariatric program were evaluated for reflux or hiatal hernia. Complete evaluation with successful intubation of esophagus and stomach was achieved in 99 patients (97.1%); the procedure was aborted prematurely in the three remaining patients (2.9%) due to patient intolerance. There were no complications in any patients. Relevant pathology was found in 63 patients (61.8%). Six (6.3%) required further investigation by pEGD despite having a complete exam. Sixty-eight patients completed the post-procedural survey; of these patients, 47 (69.1%) stated that they preferred TNE over pEGD.
Conclusions: The overall TNE experience in our series was favorable. The incidence of procedural complications was zero supporting an advantage over pEGD in our patient population. TNE demonstrated high diagnostic yield in both preoperative and postoperative settings, and need for pEGD was evaded in the vast majority of cases. Overall patients tolerated the procedure well and preferred TNE over pEGD. TNE is a safe and practical modality for investigation of foregut pathology and should be considered as an alternative to conventional pEGD in the evaluation of all bariatric patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78579
Program Number: S016
Presentation Session: Bariatric and Metabolic Surgery
Presentation Type: Podium