# Office‐based sedation‐free transnasal esophagogastroduodenoscopy with biopsies using single‐use gastroscopes: A pediatric single‐center experience

## TL;DR

This study shows that using single-use, ultra-slim gastroscopes in an office setting allows for safe and effective sedation-free endoscopy in children to monitor gastrointestinal conditions like eosinophilic esophagitis.

## Contribution

The paper introduces the use of single-use gastroscopes for sedation-free transnasal endoscopy in a pediatric office setting, with biopsy collection and high success rates.

## Key findings

- TN-EGD was successfully performed in 87.5% of patients by an experienced endoscopist newly trained in sedation-free techniques.
- Biopsies and brushings were obtained from the esophagus in all cases and from the stomach/duodenum in five cases.
- No significant adverse events were reported, and all visual and histologic findings were adequate for assessment.

## Abstract

Unsedated transnasal endoscopy (TNE) as transnasal esophagoscopy (TN‐Eso) has emerged as a promising alternative to esophagogastroduodenoscopy (EGD) under sedation to assess eosinophilic esophagitis (EoE). We report our center's experience using single‐use gastroscopes to perform sedation‐free transnasal EGD (TN‐EGD) with biopsies in an office‐based setting.

A retrospective review was performed on patients with eosinophilic esophagitis who underwent office‐based sedation‐free TNE with topical analgesia and virtual reality (VR) procedural dissociation and distraction. A sterile, single‐use, ultra‐slim 3.5 mm outer diameter, 110 cm long gastroscope with 2 mm working channel (EvoEndo) was used to perform TNE with biopsies/brushings. Data including demographics, procedure success rate, total visit time, biopsy adequacy, procedure time, procedural preference, and complications were collected.

Office‐based TNE was completed in 8 patients (six males, age range 11–20 years). The endoscope was advanced by an experienced transoral endoscopist successfully through the nares into stomach (transnasal esophagogastroscopy [TN‐EG]) in all subjects (100%) and into the duodenum (TN‐EGD) in seven subjects (87.5%). Biopsies were obtained from esophagus in all cases and from the stomach/duodenum in five cases. Histological assessment, esophageal brushing, disaccharidase enzyme analysis, or duodenal aspirate analysis were performed as indicated. EoE reevaluation was the primary indication to perform endoscopy in all patients. Visual and histologic findings were all adequate for assessment. There were no significant adverse events.

Office‐based TN‐EGD with VR procedural distraction and dissociation using single‐use gastroscopes was effective to monitor EoE, gastritis, and duodenitis in a pediatric practice.

Sedation‐free esophagoscopy with virtual reality (VR) distraction and dissociation allows for endoscopic evaluation of the esophagus and enables visualization and acquisition of biopsy samples while eliminating the risks associated with sedation and anesthesia.Sedation‐free esophagoscopy using reusable scopes is feasible, safe, successful, and cost‐effective in pediatric populations to monitor disorders of the upper gastrointestinal tract, particularly in diseases such as eosinophilic esophagitis that often require serial endoscopies.

Sedation‐free esophagoscopy with virtual reality (VR) distraction and dissociation allows for endoscopic evaluation of the esophagus and enables visualization and acquisition of biopsy samples while eliminating the risks associated with sedation and anesthesia.

Sedation‐free esophagoscopy using reusable scopes is feasible, safe, successful, and cost‐effective in pediatric populations to monitor disorders of the upper gastrointestinal tract, particularly in diseases such as eosinophilic esophagitis that often require serial endoscopies.

Single‐use, ultra‐slim gastroscopes when used in an office‐based, pediatric setting, enable sedation‐free transnasal esophagogastroduodenoscopy (TN‐EGD) with biopsies, brushings, or aspirate and is shown to be feasible, and effective.The success rate of TN‐EGD when performed by an experienced endoscopist newly trained in sedation‐free endoscopy is 87.5%.

Single‐use, ultra‐slim gastroscopes when used in an office‐based, pediatric setting, enable sedation‐free transnasal esophagogastroduodenoscopy (TN‐EGD) with biopsies, brushings, or aspirate and is shown to be feasible, and effective.

The success rate of TN‐EGD when performed by an experienced endoscopist newly trained in sedation‐free endoscopy is 87.5%.