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Transnasal esophagoscopy
Transnasal esophagoscopy (TNE) is a safe and inexpensive way to examine the esophagus in patients at risk for esophageal cancer and other disorders.〔"Transnasal Esophagoscopy". Voice Institute of New York. Retrieved August 4, 2011.〕〔Aviv JE. Esophageal Cancer Prevention: Targeting the Right Symptoms. In Aviv JE., Killing Me Softly From Inside. The Mysteries and Dangers of Acid Reflux and Its Connection to America’s Fastest Growing Cancer with a Diet That May Save Your Life. North Charleston, SC: Create Space Independent Publishing Platform 2014: 34-50.〕〔Aviv JE (2006). "Transnasal Esophagoscopy: State of the Art". Otolaryngology - Head and Neck Surgery 135 (1): 616–619.〕 TNE doesn’t require sedation, unlike other techniques widely used to look into the esophagus. This is possible because TNE uses a camera that is passed through the nose, whereas other techniques, such as upper endoscopy, are performed through the mouth, requiring a patient to be sedated. TNE, as it is used today, was developed by Jonathan E. Aviv who published his findings on the first series of TNE that he performed.〔Aviv JE, Takoudes T, Ma G, Close LG. Office-based esophagoscopy- a preliminary report. Otolaryngol Head Neck Surg 2001; 125: 170-175.〕 The origins of the idea to pass the camera through the nose date from 1993 as first described by C. A. Prescott, MD, a pediatrician otolaryngologist in Cape Town, South Africa 〔Outpatient pediatric esophagoscopy using a flexible fibreoptic bronchoscope. Design of an insufflation-aspiration adaptor. International Journal of Pediatric Otorhinolaryngology, 27(2). 113-118.〕 and further embellished by Reza Shaker, MD, a gastroenterologist in Milwaukee, WI in 1994.〔Shaker, R. (1994, June). Unsedated trans-nasal pharyngoesophagogastroduodenoscopy (T-EGD): Technique. Gastrointestinal Endoscopy, 40(3). 346-348. Aviv, J., Takoudes, T., Ma, G., Close, L. (2001). Office-based esophagoscopy: A preliminary report. Otolaryngology – Head and Neck Surgery, 125. 170-5.〕 However, it wasn't until the year 2000 when Jonathan E. Aviv, MD, published his findings on the first series of TNE he performed, that it began to have a widespread attention by ear, nose, and throat doctors.〔Aviv JE, Takoudes T, Ma G, Close LG. Office-based esophagoscopy- a preliminary report. Otolaryngol Head Neck Surg 2001; 125: 170-175.〕 Since that time it has been used by both otolaryngologists and gastroenterologists as a diagnostic tool to detect globus, dysphagia, laryngopharyngeal reflux (LPR), gastroesophageal reflux disease (GERD). TNE may also be useful in detecting Barrett's, but there is incongruence between TNE findings and biopsy results.〔Halum SL, Postma GN, Bates DD, Koufman JA (2006). Incongruence between histologic and endoscopic diagnoses of Barrett’s esophagus using transnasal esophagoscopy 116. pp. 303–307. doi:10.1097/01.mlg.0000198339.20482.7c.〕 Experts in the field suggest that TNE may replace radiographic imaging of the esophagus in otolaryngology patients with reflux, globus, and dysphagia.〔Belafsky PC, Postma GN, Daniel E, Koufman JA (2001). "Transnasal esophagoscopy". Otolaryngology - Head and Neck Surgery 15 (1): 588–589.〕
== Technique ==
Transnasal esophagoscopy is an office based procedure in which the patient is anesthetized locally in the nose and sometimes the oropharynx. The scope is advanced into the ipsilateral pyriform sinus and through the esophageal inlet to the stomach, where the esophagus can be examined, with special attention paid to the gastroesophageal (GE) junction.〔 Amin MR, Postma GN, Setzen M, Koufman JA (2008). "Transnasal esophagoscopy: A position statement from the American Broncho-Esophagological Association". Otolaryngology - Head and Neck Surgery 138 (1): 411–414.〕 An advantage of TNE over other more invasive cancer screening methods that require conscious sedationis that it can be performed using topical anesthesia alone with the patient sitting upright in an exam chair unencumbered by cardiac monitoring equipment.〔Belafsky PC, Postma GN, Daniel E, Koufman JA (2001). "Transnasal esophagoscopy". Otolaryngology - Head and Neck Surgery 15 (1): 588–589.〕
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