Comparing Nasogastric and Oral Endoscopy: Accuracy and Limitations

Regarding esophagogastroduodenoscopy (EGD)

Hello, doctor.
I need to undergo a gastroscopy, and I found some articles online.
Could you please tell me if the accuracy of a transnasal gastroscopy is lower than that of an oral gastroscopy? What are the disadvantages of a transnasal gastroscopy? Excluding what the previous doctor mentioned about the inability to remove polyps, I called the hospital to inquire about the transnasal gastroscopy, and the staff said that the clarity and accuracy are lower compared to the oral gastroscopy.
They suggested that I opt for an oral gastroscopy with sedation instead.
A few years ago, I had 2-3 gastroscopies, and I almost always ended up vomiting.
The doctor mentioned that I have a more severe gag reflex and sensitivity, so I am hesitant about whether to choose the transnasal or the sedated oral option.
I would greatly appreciate your response.
Thank you very much.

Xiang, 30~39 year old female. Ask Date: 2018/05/11

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, if the cost is more acceptable, I recommend prioritizing a painless gastroscopy.
Younger individuals have a lower chance of significant gastric diseases, so a transnasal gastroscopy can also be considered, sacrificing some resolution.
Changhua Hospital cares about your health.
Chen Shih-Tien

Reply Date: 2018/05/11

More Info

When comparing nasogastric (transnasal) endoscopy and oral endoscopy, there are several factors to consider regarding accuracy, limitations, and patient comfort.
Accuracy and Diagnostic Capability:
Both nasogastric and oral endoscopy are effective diagnostic tools for examining the upper gastrointestinal tract, including the esophagus, stomach, and duodenum. However, there are differences in their accuracy and the quality of the images they provide.
1. Transnasal Endoscopy: This method uses a thinner endoscope that is inserted through the nose. While it can provide adequate visualization of the upper GI tract, the image resolution may not be as high as that of a traditional oral endoscope. The smaller diameter of the transnasal endoscope can limit the ability to perform certain procedures, such as biopsies or polypectomies, which are often necessary for definitive diagnosis.
2. Oral Endoscopy: This method typically uses a larger, more flexible endoscope that is inserted through the mouth. The larger diameter allows for better visualization and the ability to perform therapeutic interventions, such as removing polyps or taking biopsies. Studies have shown that oral endoscopy generally provides clearer images and a more comprehensive view of the gastrointestinal tract, making it the preferred choice for many gastroenterologists, especially when detailed examination and intervention are required.

Limitations:
- Transnasal Endoscopy Limitations: The primary limitations of transnasal endoscopy include the potential for discomfort during the procedure, especially for patients who may have a sensitive gag reflex. The thinner scope may also limit the ability to perform certain diagnostic and therapeutic procedures. Additionally, some patients may find the sensation of having an instrument in their nasal passages uncomfortable, which can lead to anxiety and difficulty in completing the procedure.

- Oral Endoscopy Limitations: While oral endoscopy is generally more comfortable for many patients, it can still provoke a gag reflex, leading to nausea or vomiting during the procedure. Patients with severe anxiety or those who have difficulty lying flat may also find oral endoscopy challenging. Furthermore, the recovery time may be longer for oral endoscopy due to sedation, if used.

Patient Considerations:
Given your history of severe gag reflex and sensitivity, it is essential to weigh the options carefully. If you have previously experienced discomfort with oral endoscopy, discussing sedation options with your physician may be beneficial. Some patients find that sedation significantly reduces anxiety and discomfort, allowing for a smoother procedure.

If the primary concern is obtaining a clear diagnosis, especially if there is a suspicion of conditions such as gastroesophageal reflux disease (GERD) or other abnormalities, an oral endoscopy may be more appropriate despite the discomfort. Your physician's recommendation to consider a transnasal endoscopy may be based on your specific medical history and the need for a less invasive approach.

Conclusion:
In summary, while both nasogastric and oral endoscopy have their respective advantages and limitations, oral endoscopy generally offers higher accuracy and the ability to perform therapeutic interventions. If you are concerned about discomfort, discussing sedation options or the possibility of a transnasal approach with your healthcare provider is advisable. Ultimately, the choice of procedure should be guided by your specific medical needs, comfort level, and the expertise of your healthcare team.

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