Unsedated Transnasal Endoscopy

Certain conditions can affect the upper GI tract, such as eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD). These have traditionally been assessed, diagnosed, monitored and/or treated with traditional upper endoscopy. In this procedure, which requires sedation, providers examine the esophagus, stomach and small intestine with an endoscope inserted through the mouth.

Unsedated transnasal endoscopy is an alternative procedure that allows the child to remain awake, under local anesthesia, while their healthcare provider performs a similar examination through the nose. It takes place without IVs or sedatives, allowing children to recover faster and return to normal activities soon after the procedure. 

Once your child is seated in an upright position, an anesthetic gel will be applied to their nose and mouth to lessen pain and make them comfortable. Their doctor will insert the tiny endoscope into their nose, down their esophagus and into their stomach. Your child will be able to breathe and talk during the procedure, and parents can be with their child during the procedure.

The doctor may collect tissue biopsies using small instruments passed through the endoscope during the procedure. The doctor may pump air into your child’s upper GI tract to get a better look at tissues along the inside of the tract, which may make your child feel bloated. The procedure only takes about 10 to 20 minutes, and when it is done, the doctor removes the endoscope.

uTNE can be used for most conditions for which you would normally do an endoscopy. It is particularly appealing to patients who require frequent endoscopies to assess any changes in the disease. Children’s National uses it in patients with EoE; its use was pioneered in adults with Barrett's esophagus and its use is being extended to other conditions. 

In children ages 12 and older, uTNE at Children’s National can be used to assess or manage:

• Eosinophilic esophagitis
• Difficulty swallowing 
• Barrett’s esophagus
• Candida esophagitis
• GERD

Your child will likely recover quickly from their procedure, which is typically an outpatient procedure and does not require hospitalization unless there is a complication. Your child’s healthcare provider will examine them to make sure they are not in pain and that they don’t have any source of bleeding.

Patients can typically begin to eat or drink when the local anesthetic wears off, about a half hour after the procedure is over. They’ll also likely be cleared to restart normal activities without restrictions when they are discharged from the hospital.