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Velayutham P, Davis P, Ravichandran S, John J. A Prospective, Randomized, Double-Blind Study on the Efficacy of Different Modes of Topical Application of Nasal Anesthetics in the Diagnostic Nasal Endoscopy Procedure. Cureus 2022; 14:e29436. [PMID: 36299946 PMCID: PMC9587382 DOI: 10.7759/cureus.29436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction In the current otorhinolaryngology practice, technology has always been an essential part. Therefore, diagnostic nasal endoscopy (DNE) has become a vital examination in today’s practice. In order to visualize the nasal cavity in a systematic manner without any discomfort to both patient and doctor, the nose should be well anesthetized and decongested. Objective The study is to compare and evaluate the efficacy of 4% lignocaine-oxymetazoline cotton pledget packing versus topical sprays in the preparation of nasal cavities for DNE. Methodology The prospective, randomized, double-blind study was conducted among 246 patients and was divided into two groups. In the first group, the nose was packed with cotton pledgets containing 4% lignocaine-oxymetazoline and another group with 4% lignocaine-oxymetazoline spray. Following DNE, patients and surgeons were questioned on a pre-formed questionnaire to evaluate their experience during the procedure. Results It was observed that the time taken for the pre-endoscopic preparation of the packing group was more than the spray group. A total of 91.9% of the spray group had pain during the pre-endoscopic preparation and more burning and tingling sensation than in the nasal pack (75.6%). A total of 69.9% of the patients among the spray group participants compared to 32.5% of the packing group patients experienced more throat discomfort. In addition, 12% of the packing group had mucosal bleeding during the preparation. A total of 32.5% of the spray group experienced severe pain when compared to 12.2% of the packing group during the endoscopic procedure. Most of the participants from both groups had difficulty visualizing the superior turbinate and sphenoethmoidal recess during the procedure. There was a significant difference seen between both the groups with respect to pain during the pre-endoscopic procedure (p=0.0005), burning/tingling sensation (p<0.0001), throat pain (<0.0001), mucosal bleed (p=0.0003), pain during the procedure (p=0.0001), and discomfort after the procedure (p<0.0001). Conclusion Both methods of nasal preparation have merits and demerits in terms of discomfort, pain, and visualization of structures. Still, the packing of the nasal cavity with cotton pledgets is better when compared to spraying with 4% lignocaine-oxymetazoline. However, 4% lignocaine-oxymetazoline spray can be used during an emergency situation and with sensitive patients.
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Topical Anesthesia for Endoscopic Office-based Procedures of the Upper Aerodigestive Tract. J Voice 2018; 33:732-746. [PMID: 30017430 DOI: 10.1016/j.jvoice.2018.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/09/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Over the last two decades, an increase in office-based procedures under topical anesthesia in laryngology and head and neck oncology has occurred. Adequate anesthesia in the nasal cavity, pharynx, and larynx is essential for successful performance of these procedures. Our goal is to provide an objective summary on the available local anesthetics, methods of application, local secondary effects, efficacy, and complications. MATERIAL AND METHODS A descriptive review of literature on topical anesthesia for office-based procedures in laryngology and head and neck oncology was performed. RESULTS Lidocaine is the most applied and investigated topical anesthetic. Topical anesthesia results in decreased sensory function without impairing motor function of the pharynx and larynx. For the nasal cavity, cotton pledgets soaked in anesthetic spray and decongestant, or anesthetic gel, are effective. For the pharynx, anesthetic spray is the most frequently used and effective method. For the larynx, applying local anesthesia through a catheter through the working channel of the endoscope or anesthetic injection through the cricothyroid membrane is effective. Studies comparing the most effective application methods for each anatomical site are lacking. Complications of topical lidocaine administration are rare. CONCLUSIONS By properly applying topical anesthesia to the upper aerodigestive tract, several surgical procedures in laryngology and head and neck oncology can be performed in the outpatient clinic under topical anesthesia instead of the operating room under general anesthesia. Lidocaine is the most investigated anesthetic, with adequate efficacy and few complications. Studies that determine the most effective application methods are still wanting.
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Hu CT, Lei WY, Lin JS, Hung JS. Endoscopic meatus scoring scale versus sniff test to predict insertability before transnasal endoscopy: A prospective, randomized study. J Gastroenterol Hepatol 2017; 32:1914-1921. [PMID: 28444800 DOI: 10.1111/jgh.13810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/17/2017] [Accepted: 04/19/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM 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. METHODS A prospective randomized controlled trial to compare patient tolerance and adverse events. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Chi-Tan Hu
- 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
| | - Wei-Yi Lei
- Division of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Jen-Shung Lin
- Division of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Jui-Sheng Hung
- Division of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
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Parker C, Alexandridis E, Plevris J, O'Hara J, Panter S. Transnasal endoscopy: no gagging no panic! Frontline Gastroenterol 2016; 7:246-256. [PMID: 28839865 PMCID: PMC5369487 DOI: 10.1136/flgastro-2015-100589] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/01/2015] [Accepted: 06/10/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Transnasal endoscopy (TNE) is performed with an ultrathin scope via the nasal passages and is increasingly used. This review covers the technical characteristics, tolerability, safety and acceptability of TNE and also diagnostic accuracy, use as a screening tool and therapeutic applications. It includes practical advice from an ear, nose, throat (ENT) specialist to optimise TNE practice, identify ENT pathology and manage complications. METHODS A Medline search was performed using the terms "transnasal", "ultrathin", "small calibre", "endoscopy", "EGD" to identify relevant literature. RESULTS There is increasing evidence that TNE is better tolerated than standard endoscopy as measured using visual analogue scales, and the main area of discomfort is nasal during insertion of the TN endoscope, which seems remediable with adequate topical anaesthesia. The diagnostic yield has been found to be similar for detection of Barrett's oesophagus, gastric cancer and GORD-associated diseases. There are some potential issues regarding the accuracy of TNE in detecting small early gastric malignant lesions, especially those in the proximal stomach. TNE is feasible and safe in a primary care population and is ideal for screening for upper gastrointestinal pathology. It has an advantage as a diagnostic tool in the elderly and those with multiple comorbidities due to fewer adverse effects on the cardiovascular system. It has significant advantages for therapeutic procedures, especially negotiating upper oesophageal strictures and insertion of nasoenteric feeding tubes. CONCLUSIONS TNE is well tolerated and a valuable diagnostic tool. Further evidence is required to establish its accuracy for the diagnosis of early and small gastric malignancies. There is an emerging role for TNE in therapeutic endoscopy, which needs further study.
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Affiliation(s)
- Clare Parker
- South Tyneside NHS Foundation Trust, South Tyneside District Hospital, South Shields, UK
| | | | - John Plevris
- Centre for Liver and Digestive Disorders, The Royal Infirmary, University of Edinburgh, Edinburgh, UK
| | - James O'Hara
- Department of Otolaryngology, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Simon Panter
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, Newcastle upon Tyne, UK
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Şahin Mİ, Kökoğlu K, Güleç Ş, Ketenci İ, Ünlü Y. Premedication Methods in Nasal Endoscopy: A Prospective, Randomized, Double-Blind Study. Clin Exp Otorhinolaryngol 2016; 10:158-163. [PMID: 27459198 PMCID: PMC5426394 DOI: 10.21053/ceo.2016.00563] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/07/2016] [Accepted: 06/17/2016] [Indexed: 11/22/2022] Open
Abstract
Objectives To identify the optimal pharmacological method of preparing patients for nasal endoscopy. Methods Twenty healthy volunteers were enrolled in this prospective, randomized, double-blind study. Four types of medications were applied in their nostrils with binary combinations of spray bottles on four different days in a random order: placebo (normal saline [NS]+NS), decongestant (NS+oxymetazoline), anesthetic (NS+lidocaine), and decongestant plus anesthetic (oxymetazoline+lidocaine). Rigid nasal endoscopy was performed 10 minutes after spray application. The volunteers evaluated the discomfort caused by each spray application, and nasal pain scores due to the passage of the endoscope. The physicians quantified nasal decongestion using a visual analogue scale. Endoscopy duration as well as pulse and mean blood pressure (MBP) before spray application, 10 minutes after the application, and immediately after endoscopic examination were also recorded. Results The discomfort caused by lidocaine was significantly higher than that caused by the other sprays (P<0.001). The lowest pain score related to endoscopy was obtained for oxymetazoline+lidocaine (P<0.001). Nasal decongestion was best achieved with NS+oxymetazoline (P<0.001). Endoscopy duration was the shortest for oxymetazoline+ lidocaine (P<0.05). Statistically significant MBP changes were only seen with the application of NS+oxymetazoline (P<0.05). However, neither MBP nor pulse rate change was significant clinically. Conclusion Application of decongestant and anesthetic sprays together seems to be the best method of pharmacological preparation of patients for nasal endoscopy.
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Affiliation(s)
- Mehmet İlhan Şahin
- Department of Otolaryngology, Erciyes University Medical School, Kayseri, Turkey
| | - Kerem Kökoğlu
- Department of Otolaryngology, Erciyes University Medical School, Kayseri, Turkey
| | - Şafak Güleç
- Department of Otolaryngology, Akdağmadeni State Hospital, Yozgat, Turkey
| | - İbrahim Ketenci
- Department of Otolaryngology, Erciyes University Medical School, Kayseri, Turkey
| | - Yaşar Ünlü
- Department of Otolaryngology, Erciyes University Medical School, Kayseri, Turkey
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Saif AM, Farboud A, Delfosse E, Pope L, Adke M. Assessing the safety and efficacy of drugs used in preparing the nose for diagnostic and therapeutic procedures: a systematic review. Clin Otolaryngol 2016; 41:546-63. [PMID: 26452438 DOI: 10.1111/coa.12563] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Local anaesthetics and vasoconstrictors are essential for pain control and to aid intra-operative haemostasis in nasal procedures. They also improve access, and reduce discomfort when performing nasal endoscopy. There are no clear guidelines on preparing the nose despite evermore diagnostic and therapeutic procedures utilising the nose as a point of access. OBJECTIVE OF REVIEW This review aims to identify nasal preparations used in diagnostic and therapeutic nasal procedures and to examine their safety and efficacy. TYPE OF REVIEW Systematic review. SEARCH STRATEGY A search was carried out using PubMed, MEDLINE, Ovid EMBASE, the Cochrane library and references from the included articles. EVALUATION METHOD The inclusion criteria included: full-text English language articles with regard to nasal preparation for surgery. Case reports, systematic reviews, meta-analysis, double-blind placebo controlled randomised trials (RCTs) and case series were included. RESULTS A total of 53 articles were retrieved: 13 articles on nasal preparation for operative procedures, six on functional endoscopic sinus surgery and 22 on nasendoscopy as well as six case reports. Cocaine was the most widely used topical preparation for operative procedures but was associated with more side-effects; thus, topical tetracaine and levobupivacaine infiltration are alternatives with equivalent efficacy but reduced adverse effects. All articles reviewed for functional endoscopic sinus surgery used a mixture containing lidocaine, adrenaline or both. Flexible nasendoscopy causes minimal patient discomfort and preparation is only recommended in selected patients, in contrast to rigid nasendoscopy which requires preparation. CONCLUSION For operative procedures, such as septorhinoplasty, a single agent tetracaine or levobupivicaine provides an improved surgical field. In functional endoscopic sinus surgery, lidocaine-adrenaline preparations have resulted in significantly better surgical and patient outcomes. There is little evidence to support the routine use of pre-procedural nasal preparation for flexible nasendoscopy. Those undergoing rigid endoscopy conversely always require the use of a vasoconstrictor and local anaesthetic. Pre-procedure assessment of patients is recommended, with agents being reserved for those with low pain thresholds, high anxiety and small nasal apertures presenting resistance to the insertion of the endoscope.
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Affiliation(s)
- A M Saif
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | | | - E Delfosse
- Kings College NHS Trust, South Thames Deanery, London, UK
| | - L Pope
- Singleton Hospital, Swansea, UK
| | - M Adke
- Wrexham Maelor Hospital, Wrexham, UK
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Friedlander JA, DeBoer EM, Soden JS, Furuta GT, Menard-Katcher CD, Atkins D, Fleischer DM, Kramer RE, Deterding RR, Capocelli KE, Prager JD. Unsedated transnasal esophagoscopy for monitoring therapy in pediatric eosinophilic esophagitis. Gastrointest Endosc 2016; 83:299-306.e1. [PMID: 26142551 PMCID: PMC4698253 DOI: 10.1016/j.gie.2015.05.044] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/25/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Unsedated transnasal endoscopy (TNE) is safer and less costly than sedated EGD. The aim of this study was to evaluate the performance of TNE with biopsies in monitoring the esophageal mucosa of pediatric patients with eosinophilic esophagitis. METHODS Patients between 8 and 17 years of age with eosinophilic esophagitis and their parents were enrolled. Unsedated TNE was performed. A 2.8-mm (1.2-mm channel) or a 4-mm flexible bronchoscope (2-mm channel) was used, and esophageal biopsy specimens were obtained. Biopsy specimen analysis, duration, adverse events, and billing charges of TNE were assessed. Immediately after TNE and a minimum of 2 weeks later, a modified Group Health Association of America 9 survey and a preference questionnaire were completed, respectively. RESULTS Twenty-one of 22 enrolled patients underwent TNE. TNE was performed with no serious adverse events. Histopathological analysis revealed 0 eosinophils per high-power field (n = 12), fewer than 15 eosinophils per high-power field (n = 4), and more than 15 eosinophils per high-power field (n = 5). The total epithelial surface area of mucosal biopsy samples from either TNE Forceps (1.2 mm or 2 mm biopsy channel forceps) compared with those obtained during the subject's previous EGD by using standard endoscopic forceps was not statistically different (P = .308 [1.2 mm]/P = .492 [2 mm]). All parents and 76.2% of subjects would undergo the TNE again. TNE was preferred over EGD by 85.7% of parents and 52.4% of subjects. The modified Group Health Association of America 9 survey revealed a high degree of satisfaction (average, 43.19 ± 2.6; maximum score, 45). Charges associated with TNE were 60.1% lower than for previous EGDs. CONCLUSIONS Unsedated TNE is an effective, lower-cost procedure for monitoring the esophageal mucosa of children with eosinophilic esophagitis.
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Affiliation(s)
- Joel A. Friedlander
- Digestive Health Institute, Children’s Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA
- Aerodigestive Program, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Emily M. DeBoer
- Aerodigestive Program, Children’s Hospital Colorado, Aurora, Colorado, USA
- Breathing Institute, Children’s Hospital Colorado, Section of Pulmonary Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jason S. Soden
- Digestive Health Institute, Children’s Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA
- Aerodigestive Program, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Glenn T. Furuta
- Digestive Health Institute, Children’s Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA
- Gastrointestinal Eosinophilic Diseases Program, Children’s Hospital of Colorado, Aurora, Colorado, USA
| | - Calies D. Menard-Katcher
- Digestive Health Institute, Children’s Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA
- Gastrointestinal Eosinophilic Diseases Program, Children’s Hospital of Colorado, Aurora, Colorado, USA
| | - Dan Atkins
- Gastrointestinal Eosinophilic Diseases Program, Children’s Hospital of Colorado, Aurora, Colorado, USA
- Allergy Section, Children’s Hospital Colorado, Section of Allergy, Immunology, and Rheumatology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David M. Fleischer
- Gastrointestinal Eosinophilic Diseases Program, Children’s Hospital of Colorado, Aurora, Colorado, USA
- Allergy Section, Children’s Hospital Colorado, Section of Allergy, Immunology, and Rheumatology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Robert E. Kramer
- Digestive Health Institute, Children’s Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Robin R. Deterding
- Aerodigestive Program, Children’s Hospital Colorado, Aurora, Colorado, USA
- Breathing Institute, Children’s Hospital Colorado, Section of Pulmonary Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kelley E. Capocelli
- Division of Pediatric Pathology, Children’s Hospital of Colorado, Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jeremy D. Prager
- Aerodigestive Program, Children’s Hospital Colorado, Aurora, Colorado, USA
- Department of Otolaryngology, Children’s Hospital Colorado, Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Hu CT. Anterior meatuscopy is more reliable than a sniff test for predicting nasal patency before transnasal endoscopy. Endosc Int Open 2015; 3:E538-46. [PMID: 26716108 PMCID: PMC4683136 DOI: 10.1055/s-0034-1392772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Unsedated transnasal esophago-gastro-duodenoscopy (UT-EGD) has been performed for at least two decades but many techniques related to the procedure have yet to be standardized. We aimed to develope a simple endoscopic method, anterior meatuscopy, to replace the sniff test for selecting the most patent nasal meatus before UT-EGD. We hypothesized that access to the common nasal meatus (CNM), if confirmed by anterior meatuscopy, was a safer route than the inferior (INM) and middle nasal meatuses (MNM) because it would result in reduced epistaxis, nasal pain, and nasal discharge. PATIENTS AND METHODS We used anterior meatuscopy and an endoscopic meatus scoring scale (EMSS) to identify the optimal meatus for insertion. We evaluated the EMSS frequency distributions for the INM, CNM, and MNM and the reliability of a sniff test in 1,000 consecutive patients. The adverse effects of passing through the CNM versus the INM and MNM, respectively, were compared. RESULTS In the INM and MNM, the EMSS frequencies were grade I > II > III > 0 whereas those in the CNM were grade II > I > 0 > III. A sniff test was not reliable, given its low sensitivity (63.3 %), specificity (67.3 %), positive predictive value (69.1 %), negative predictive value (61.4 %), and accuracy (65.2 %). Although only 9.2 % of our patients had grade III anterior-to-posterior CNMs, passage through this spacious CNM rather than through the MNM or the INM could significantly reduce epistaxis, nasal pain, and nasal discharge. CONCLUSIONS Anterior meatuscopy is more reliable than a sniff test before UT-EGD. Transnasal endoscopic passage through the endoscopically patent CNM, if detected by anterior meatuscopy, may prevent epistaxis and nasal pain and minimize nasal discharge.
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Affiliation(s)
- Chi-Tan Hu
- 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,Corresponding author Chi-Tan Hu, MD, PhD Division of GastroenterologyDepartment of Internal MedicineBuddhist Tzu Chi Hospital and Tzu Chi UniversityNo 707 Section 3Chung Yang RoadHualien (970)Taiwan+886-3-8567043
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A pilot study assessing tolerance safety and feasibility of diagnostic transnasal esophagogastroduodenoscopy using an improved larger caliber endoscope and an adapted topical anesthesia. Surg Endosc 2014; 29:3002-9. [DOI: 10.1007/s00464-014-4025-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/02/2014] [Indexed: 01/03/2023]
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Lee YS, Bang CS, Suk KT, Lee YH, Ham YL, Sung H, Ko JS, Kim WW, Kim JH, Kim HS, Park HJ, Kim MS. Catheter-free method is sufficient for preparation for transnasal endoscopy: randomized controlled trial. Dig Endosc 2014; 26:385-91. [PMID: 24283587 DOI: 10.1111/den.12209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/23/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Although transnasal endoscopy (TNE) is generally a comfortable and safe procedure, it has some disadvantages, such as complicated preprocessing and occasional repulsion reaction during catheterization. In an attempt to simplify the preprocessing method, the efficacy of a catheter-free method in which a catheter is not inserted into the nasal cavity was assessed. METHODS The present study was a prospective, open-label, single-center, randomized controlled study with parallel assignment allocation 1:1. Between March 2009 and August 2009, a total of 93 TNE-naïve patients were enrolled and randomized. Patients were prospectively randomized into two groups (catheter-free vs catheter-insertion method). Patients who prepared according to the catheter-free method and who were unsuccessful underwent the catheter-insertion method. Clinical characteristics, success rate, complications, vital signs, acceptability, and tolerability were assessed and compared. RESULTS Success rates of the catheter-free and catheter-insertion methods were 88% (n=44) and 88% (n=38) (P>0.05), respectively. Causes of failure in the catheter-free method included severe rhinalgia (n=1, 2%) and narrowing of the nasal cavity (n=5, 10%). Causes of failure in the catheter-insertion method included narrowing of the nasal cavity (n=5, 11%). Six patients whose TNE failed with the catheter-free method also experienced failed TNE with the catheter-insertion method. There were no statistical differences in vital signs, acceptability, and tolerability. CONCLUSION The catheter-free method is sufficient for preparation for TNE. The success rate of TNE depends more on the structure of the nasal cavity than the preprocessing method.
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Affiliation(s)
- Yong Sub Lee
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
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Hwang SH, Park CS, Kim BG, Cho JH, Kang JM. Topical anesthetic preparations for rigid and flexible endoscopy: a meta-analysis. Eur Arch Otorhinolaryngol 2014; 272:263-70. [PMID: 24682602 DOI: 10.1007/s00405-014-3012-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/15/2014] [Indexed: 12/30/2022]
Abstract
Transnasal endoscopy can cause pain or discomfort for the patient. Topical anesthetic has been used in an attempt to reduce this. However, there is no consensus on whether topical anesthetic is effective in optimizing patient experience during the procedure. The goal of this study was to perform a systematic review with meta-analysis of the efficacy of topical anesthetic on pain and comfort outcomes during endoscopy. Two authors independently searched the databases from inception to September 2013. Studies comparing topical anesthetic with placebo where the outcomes of interest were pain, comfort, or side effect outcomes were included. Sufficient data for meta-analysis were retrieved for ten trials with a total of 837 patients. The evidence suggests that local anesthetic alone or in combination with a vasoconstrictor is beneficial to patients' pain [standardized mean difference (SMD) = -0.21; p = 0.045] and comfort (SMD = -0.51; p < 0.001) outcomes when performing transnasal endoscopy. However, the topical anesthetic caused unpleasant sensation with respect to an unpleasant taste (SMD = 0.77; p < 0.001). In addition, there was no significant difference between a topical anesthetic spray and cotton type in pain and discomfort values. Applying topical anesthetic during transnasal endoscopy could reduce pain and discomfort. The spray and cotton type methods of topical anesthetic preparation showed no significant difference in terms of pain and discomfort during the procedure. However, further trials with good research methodology should be conducted to confirm our results.
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Affiliation(s)
- Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Bucheon St. Mary`s Hospital, The Catholic University of Korea, 327 Sosa-ro, Wonmi-gu, Bucheon-city, Gyeonggi-do, 420-717, Republic of Korea
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12
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Let your patients watch and talk during examination: A review of unsedated transnasal endoscopy. Tzu Chi Med J 2013. [DOI: 10.1016/j.tcmj.2013.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hu CT. Cotton pledget packing versus topical spray for nasal preparation: merits and demerits are answered by a strict randomized controlled trial. Eur Arch Otorhinolaryngol 2012; 270:1763-4. [PMID: 23233314 DOI: 10.1007/s00405-012-2312-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 11/30/2012] [Indexed: 11/25/2022]
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Mishra P, Kaushik M, Dehadaray A, Qadri H, Raichurkar A, Seth T. Preparation of nose for nasal endoscopy: cotton pledget packing versus topical spray. A prospective randomized blinded study. Eur Arch Otorhinolaryngol 2012; 270:117-21. [PMID: 22427029 DOI: 10.1007/s00405-012-1980-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 02/21/2012] [Indexed: 11/30/2022]
Abstract
During nasal endoscopy it is essential to have proper visualization of structures with minimal discomfort to patient and surgeon. For this it is essential that the nose is well prepared before the procedure. The main objective of the study is to compare and evaluate the efficacy of cotton pledget packing versus topical sprays in preparation of nose for nasal endoscopy. The method includes prospective randomized blinded study on 100 patients. Patients were randomly divided in two groups. In first group the nose was packed with 4% lignocaine with xylometazoline nasal drops and in the other group it was prepared with 10% lignocaine topical spray and xylometazoline nose drops. Following the procedure, patient and the surgeon were asked a pre-formed questionnaire to know their experience during endoscopy. It was observed the packing group required more preparatory time as compared to the spray group. The group which was packed had less discomfort, less pain while endoscopy. The visualization of structures was significantly better in the packed group. Eight patients in the packed group did have some mucosal bleed during the process of packing which was not seen in the spray group. Both methods of preparation have merits and demerits but in terms of discomfort, pain during procedure and visualization of structure, packing of nasal cavity with 4% lignocaine and xylometazoline drops is better than spraying of nose with 10% lignocaine and xylometazoline drops.
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Affiliation(s)
- Prasun Mishra
- Department of ENT-HNS, Bharatividyapeeth Deemed University Medical College, Pune, India.
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Hu CT. Nasal anesthesia and body position changes: lessons learned from self-performed, transnasal EGD. Gastrointest Endosc 2010; 71:1277-9. [PMID: 20598254 DOI: 10.1016/j.gie.2010.01.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 01/26/2010] [Indexed: 12/10/2022]
Affiliation(s)
- Chi-Tan Hu
- Division of Gastroenterology and Research Centre for Hepatology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Graduate Institute of Clinical Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
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