Balassone Valerio, Dauri Mario, Cappuccio Roberto, Di Camillo Mauro, Benavoli Domenico, Buonomo Oreste, Petrella Giuseppe, Stroppa Italo
Emergency and Operative Digestive Endoscopy Unit - Department of Medicine - Fondazione PTV, Policlinico Tor Vergata, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
Department of General Surgery - Fondazione PTV, Policlinico Tor Vergata, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
Surg Endosc. 2015 Oct;29(10):3002-9. doi: 10.1007/s00464-014-4025-5. Epub 2014 Dec 17.
Transnasal esophagogastroduodenoscopy (TN-EGDS) is well tolerated by patients and the examination is perceived comfortable without the need of a sedative drug. Conversely, mainly in Western literature, some authors report limitations in illumination, image quality, and working channel as affecting TN-EGDS diffusion. To overcome these disadvantages, a new transnasal endoscope (TNE) was tested but, due to its larger diameter, we have no evidence of its clinical safety and tolerability. A new adapted nasal anesthesia could be useful to improve TNE tolerance. In an independent, not sponsored, pilot prospective study we enrolled, in a busy clinical hospital setting, 30 adult patients receiving nasal atomized Lidocaine and Xylometazoline (XAL) to undergo a diagnostic TN-EGDS with TNE to evaluate its tolerance, safety, and feasibility.
Three physicians enrolled inpatients and outpatients with indication to diagnostic EGDS during a 6-month period. Main outcome measures were cardio-pulmonary monitoring data and patients' answers to an adapted questionnaire investigating pain, anxiety level, willingness to repeat the examination, operators' scores about endoscopy quality, examination conduction and anesthesia-related complications.
The examination was completed by the transnasal route in 100 % of the enrolled patients, endoscopy satisfaction and feasibility were scored to nearly the highest levels by the three different physicians. A total of 29/30 patients (96.6 %) declared the willingness to repeat the same examination if needed. The mean patients' score for overall pain was 3.7 ± 1 SD (range 1-10 by Visual Analog Scale). Mean endoscopy duration was 11.1 ± 2.6 min (range 5.0-19.0). In a total of 17/30 TN-EGDS that lasted more than 11 min, higher heart frequency variations and worse tolerance scores were found (p < 0.05).
Our pilot study demonstrates that TN-EGDS with TNE and NA is safe, well tolerated, and feasible. The best clinical tolerance is reached when TN-EGDS lasts <11 min.
经鼻食管胃十二指肠镜检查（TN-EGDS）患者耐受性良好，无需使用镇静药物即可舒适地完成检查。相反，主要在西方文献中，一些作者报告了照明、图像质量和工作通道方面的局限性影响了TN-EGDS的推广。为克服这些缺点，对一种新型经鼻内窥镜（TNE）进行了测试，但由于其直径较大，我们尚无其临床安全性和耐受性的证据。一种新的适应性鼻内麻醉可能有助于提高对TNE的耐受性。在一项独立的、非赞助的前瞻性试点研究中，我们在一家繁忙的临床医院环境中招募了30名成年患者，这些患者接受鼻内雾化利多卡因和赛洛唑啉（XAL），使用TNE进行诊断性TN-EGDS，以评估其耐受性、安全性和可行性。
三名医生在6个月期间招募了有诊断性EGDS指征的住院患者和门诊患者。主要观察指标为心肺监测数据以及患者对一份适应性问卷的回答，该问卷调查疼痛、焦虑程度、重复检查的意愿、操作人员对内镜质量、检查操作和麻醉相关并发症的评分。
100%的入组患者通过经鼻途径完成了检查，三位不同的医生对内镜检查的满意度和可行性评分几乎达到了最高水平。共有29/30名患者（96.6%）表示如有需要愿意重复相同的检查。患者总体疼痛的平均评分为3.7±1标准差（视觉模拟量表评分范围为1-10）。平均内镜检查持续时间为11.1±2.6分钟（范围为5.0-19.0）。在总共17/30例持续时间超过11分钟的TN-EGDS检查中，发现心率变化更高且耐受性评分更差（p<0.05）。
我们的试点研究表明，使用TNE和NA的TN-EGDS是安全的、耐受性良好且可行的。当TN-EGDS持续时间<11分钟时，可达到最佳临床耐受性。
