Safety and efficacy of a novel ultrathin gastroscope for unsedated transnasal endoscopy in children and adults for evaluation of upper GI disorders.

Background and Aims: Sedation-free transnasal endoscopy (TNE) is a valuable tool for endoscopic evaluation of the upper GI tract without the risk of general anesthesia. In pediatrics, bronchoscopes are often used for TNE, which precludes gastroduodenal evaluation. We evaluated the use of a novel ultrathin (3.5-mm) gastroscope. Methods: This multicenter retrospective study involved 7 U.S. hospitals from May 2022 to July 2023. Data were collected from the electronic medical record. The primary outcome was the safety and efficacy measured by completion rate and adverse events. Secondary outcomes were procedure and encounter duration and biopsy sample adequacy. Results: Fifty-three patients were recruited. Indications were eosinophilic esophagitis surveillance (n = 51) and esophageal variceal evaluation (n = 2). Mean patient age was 15.1 years (range, 6-37 years) with a male predominance (84.9%). Four procedures were unable to be completed. The procedure was successful in 92.4%, and the device success rate was 94.3%. Extent of intended accessibility was transnasal esophagoscopy in 3 patients, transnasal esophagogastroscopy in 42 patients, and transnasal EGD in 4 patients. Almost 40% underwent TNE for the first time. Biopsy samples obtained were adequate for histopathologic analyses. No significant adverse events were observed. Five patients (9.4%) experienced minimal epistaxis, gagging, and nasal pain. Conclusions: Sedation-free TNE using a single-use gastroscope was well tolerated and safe in pediatric and adult age groups with a success rate similar to previous studies. User feedback noted that the single-use gastroscopes provided improved visualization, increased length, and larger working channel to allow for diagnostic EGD in an efficient ambulatory setting without general anesthesia.