Hu Chi-Tan, Lei Wei-Yi, Lin Jen-Shung, Hung Jui-Sheng
Division of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
Graduate Institute of Clinical Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan.
J Gastroenterol Hepatol. 2017 Dec;32(12):1914-1921. doi: 10.1111/jgh.13810.
Sniff test is a common method before unsedated transnasal esophago-gastro-duodenoscopy (UT-EGD) to select a nostril insertion site. Yet there is no objective method to select a more specific meatus insertion tract for anesthesia and insertion. We devised an endoscopic meatus scoring scale by anterior meatuscopy to select the most optimal meatus insertion tract. We hypothesized that meatuscopy instead of sniff test might improve tolerance and reduce adverse events during nasal anesthesia and UT-EGD.
A prospective randomized controlled trial to compare patient tolerance and adverse events.
A total of 359 patients were assessed and finally 310 patients were analyzed. There were no statistical differences in patient characteristics and insertion failure rates. Pain scores during nasal anesthesia, nasal insertion/exsertion, UT-EGD, and overall tolerance were significantly lower in the meatuscopy group than sniff test group. Compared with the sniff tested patients, the meatuscopied patients had significantly lower epistaxis rates during insertion/exsertion, better visual capacity after decongestive anesthesia, and shorter total procedure time. A significantly higher proportion of the meatuscopied than sniff tested patients would like to receive the same procedure next time. Nasal discharge, nasal pain, epistaxis, and blowing out blood clots occurred significantly less frequent in the meatuscopy group than sniff test group. More sniff tested than meatuscopied patients had headache, delayed epistaxis, and sinusitis although they were not statistically significant.
Selection of an optimal meatus insertion tract by an anterior meatuscopy causes lesser nasal pain, epistaxis, and post-procedural side effects in nasal anesthesia and UT-EGD than the conventional sniff test.
嗅气试验是未镇静经鼻食管-胃-十二指肠镜检查（UT-EGD）前选择鼻孔插入部位的常用方法。然而，尚无客观方法来选择更具体的鼻道插入路径用于麻醉和插入操作。我们通过前鼻道镜检查设计了一种鼻道评分量表，以选择最佳的鼻道插入路径。我们假设鼻道镜检查而非嗅气试验可能会提高耐受性，并减少鼻麻醉和UT-EGD期间的不良事件。
一项前瞻性随机对照试验，比较患者耐受性和不良事件。
共评估了359例患者，最终分析了310例患者。患者特征和插入失败率无统计学差异。鼻道镜检查组在鼻麻醉、鼻腔插入/拔出、UT-EGD期间的疼痛评分以及总体耐受性均显著低于嗅气试验组。与嗅气试验患者相比，鼻道镜检查患者在插入/拔出过程中的鼻出血发生率显著更低，减充血麻醉后的视觉能力更好，总操作时间更短。鼻道镜检查患者下次愿意接受相同操作的比例显著高于嗅气试验患者。鼻道镜检查组的鼻分泌物、鼻痛、鼻出血和咳出血凝块的发生率显著低于嗅气试验组。嗅气试验患者比鼻道镜检查患者出现头痛、延迟性鼻出血和鼻窦炎的更多，尽管差异无统计学意义。
与传统的嗅气试验相比，通过前鼻道镜检查选择最佳鼻道插入路径在鼻麻醉和UT-EGD中引起的鼻痛、鼻出血和术后副作用更少。
