Transnasal endoscopy: moving from endoscopy to the clinical outpatient-blue sky thinking in oesophageal testing.
BARRETT'S OESOPHAGUS
COVID-19
DYSPHAGIA
ENDOSCOPY
OESOPHAGEAL VARICES
Journal
Frontline gastroenterology
ISSN: 2041-4137
Titre abrégé: Frontline Gastroenterol
Pays: England
ID NLM: 101528589
Informations de publication
Date de publication:
2022
2022
Historique:
received:
18
03
2022
accepted:
03
05
2022
entrez:
11
7
2022
pubmed:
12
7
2022
medline:
12
7
2022
Statut:
epublish
Résumé
COVID-19 has severely affected UK endoscopy services with an estimate 86% loss of activity during the first wave. Subsequent delays in diagnostic and surveillance procedures highlight the need for novel solutions to tackle the resultant backlog. Transnasal endoscopy (TNE) provides an attractive option compared with conventional upper gastrointestinal endoscopy given its limited use of space, no sedation and reduced nursing resources. We describe piloting and then establishing an outpatient model TNE service in the pandemic era and the implications on resource allocation, training and workforce. We also discuss our experiences and outline ways in which services can evolve to undertake more complex endoscopic diagnostic and therapeutic work. Over 90% of patients describe no discomfort and those who have previously experienced conventional transoral endoscopy preferred the transnasal approach. We describe a low complication rate (0.8%) comprising two episodes of mild epistaxis. The average procedure duration was reasonable (9.9±5.0 min) with full adherence to Joint Advisory Group quality standards. All biopsies assessed were deemed sufficient for diagnosis including those for surveillance procedures. TNE can offer a safe, tolerable, high-quality service outside of a conventional endoscopy setting. Expanding procedural capacity without impacting on the current endoscopy footprint has great potential in recovering endoscopy services following the COVID-19 pandemic. Looking forward, TNE has potential to be used both within the endoscopy suite as part of therapeutic procedures, or outside of the endoscopy unit in outpatient clinics, community hospitals, or mobile units and to achieve this in a more sustainable and environmentally friendly way.
Sections du résumé
Background
UNASSIGNED
COVID-19 has severely affected UK endoscopy services with an estimate 86% loss of activity during the first wave. Subsequent delays in diagnostic and surveillance procedures highlight the need for novel solutions to tackle the resultant backlog. Transnasal endoscopy (TNE) provides an attractive option compared with conventional upper gastrointestinal endoscopy given its limited use of space, no sedation and reduced nursing resources.
Our experience
UNASSIGNED
We describe piloting and then establishing an outpatient model TNE service in the pandemic era and the implications on resource allocation, training and workforce. We also discuss our experiences and outline ways in which services can evolve to undertake more complex endoscopic diagnostic and therapeutic work. Over 90% of patients describe no discomfort and those who have previously experienced conventional transoral endoscopy preferred the transnasal approach. We describe a low complication rate (0.8%) comprising two episodes of mild epistaxis. The average procedure duration was reasonable (9.9±5.0 min) with full adherence to Joint Advisory Group quality standards. All biopsies assessed were deemed sufficient for diagnosis including those for surveillance procedures.
Discussion
UNASSIGNED
TNE can offer a safe, tolerable, high-quality service outside of a conventional endoscopy setting. Expanding procedural capacity without impacting on the current endoscopy footprint has great potential in recovering endoscopy services following the COVID-19 pandemic. Looking forward, TNE has potential to be used both within the endoscopy suite as part of therapeutic procedures, or outside of the endoscopy unit in outpatient clinics, community hospitals, or mobile units and to achieve this in a more sustainable and environmentally friendly way.
Identifiants
pubmed: 35812036
doi: 10.1136/flgastro-2022-102129
pii: flgastro-2022-102129
pmc: PMC9234731
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e65-e71Informations de copyright
© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Frontline Gastroenterol. 2020 Jun 24;12(6):451-460
pubmed: 34712462
Frontline Gastroenterol. 2016 Oct;7(4):246-256
pubmed: 28839865
J Dig Dis. 2012 Jun;13(6):310-5
pubmed: 22624554
Endosc Int Open. 2017 Jul;5(7):E646-E651
pubmed: 28691048
Frontline Gastroenterol. 2018 Jul;9(3):214-220
pubmed: 30046427
Otolaryngol Clin North Am. 2019 Jun;52(3):577-587
pubmed: 30905563
J Gastroenterol Hepatol. 2012 Aug;27(8):1384-7
pubmed: 22497665
J Clin Gastroenterol. 2010 Jan;44(1):12-7
pubmed: 19661817
Clin Res Hepatol Gastroenterol. 2014 Apr;38(2):209-18
pubmed: 24268304
Arch Otolaryngol Head Neck Surg. 2009 Aug;135(8):781-3
pubmed: 19687398
Frontline Gastroenterol. 2018 Apr;9(2):105-109
pubmed: 29588837
Gut. 2021 Mar;70(3):537-543
pubmed: 32690602
Gut. 2018 Jun;67(6):1000-1023
pubmed: 29478034
Dig Dis Sci. 2022 Jun;67(6):1937-1947
pubmed: 35239094
Gut. 2021 Sep;70(9):1611-1628
pubmed: 34362780
Am J Gastroenterol. 2015 Jan;110(1):148-58
pubmed: 25488897
Gastrointest Endosc. 2008 Mar;67(3):410-8
pubmed: 18155215
Lancet Oncol. 2020 Aug;21(8):1023-1034
pubmed: 32702310
Frontline Gastroenterol. 2019 Jan;10(1):7-15
pubmed: 30651952
Dig Endosc. 2016 Apr;28 Suppl 1:25-31
pubmed: 26792612
Clin Endosc. 2021 Jul;54(4):618-620
pubmed: 33652517
Gastrointest Endosc. 2022 Jun 2;:
pubmed: 35659608
World J Gastroenterol. 2007 Feb 14;13(6):906-11
pubmed: 17352021
Gastrointest Endosc. 2003 Feb;57(2):198-204
pubmed: 12556784
Aliment Pharmacol Ther. 2014 Sep;40(5):467-76
pubmed: 25039412
Liver Int. 2018 Aug;38(8):1418-1426
pubmed: 29323459
Lancet Gastroenterol Hepatol. 2020 Jul;5(7):636-638
pubmed: 32553141