Transnasal Endoscopy

A transnasal endoscopy is a test which allows us to look directly at the upper part of your digestive system – the oesophagus (food pipe), stomach and duodenum (the first part of the small bowel). 

A thin, flexible tube with a camera at the end (called an endoscope) is placed into the nose and then down your oesophagus and into your stomach. Tissue samples can be taken at the same time if they are needed. A transnasal endoscopy can help to find the cause of a number of symptoms including: 

• indigestion
• losing weight without trying
• anaemia
• a lump in the throat
• heartburn
• being sick (vomiting)
• difficulty swallowing.

Most endoscopies are done using a camera which is placed into your mouth which can cause gagging and retching. Some patients find this very uncomfortable, even when local anaesthetic spray is used to numb the back of the throat. They will therefore be given medication to make them sleepy and relaxed through a needle placed in the back of the hand or arm. This medication can take several hours to wear off. 

With transnasal endoscopy, a smaller camera is used (half a centimetre across) and it is placed into the nose instead of the mouth. Many patients find this more comfortable with little or no retching and gagging. This means that sedation is not required and you can go home straight after the procedure. A local anaesthetic spray is used to numb your nose. Since the camera is not placed in your mouth you will be able to swallow and speak normally.

For most people a transnasal endoscopy is a simple and safe procedure but there are risks. Unusual complications which can occur include: 

• soreness in your nose – this usually goes away in a few hours. 
• nosebleed – this occurs in around one in every fifty patients and usually stops a minute or two after the procedure. 
• a hole (perforation) or tear in the lining of the oesophagus, stomach or duodenum - this occurs in less than one in every ten thousand procedures. If this happens, you may have to be admitted to hospital for tests and you may need an operation to repair the hole.
• bleeding – significant bleeding occurs in less than one in every thousand procedures. You may need to be admitted to hospital for treatment. 
• chest infection 
• missed lesion – although an endoscopy is the best procedure to help diagnose many problems, no procedure is perfect. There is a small risk that we might miss a lesion or other important finding during your procedure.

Most people can have a transnasal endoscopy but it may not be suitable for you if: 

• you have a blocked nose on both sides. 
• you have had a recent injury to, or surgery, on your nose. 
• you suffer from frequent nosebleeds. 

If any of these apply to you, please let us know in advance so that we can tell you if you can have the procedure or not.

The main alternative to transnasal endoscopy is a standard endoscopy through the mouth using throat spray or under sedation.

Sometimes a CT scan can be used as an alternative to endoscopy or you may be able to have a barium swallow test (where you drink contrast dye which shows up on X-ray, allowing us to see the outline of the organs). However, these tests provide different information and sometimes they are requested in addition to an endoscopy. One disadvantage of both a CT scan and barium swallow is that it is not possible to take tissue samples. Please contact us in advance if you would like to discuss alternatives. 

Eating and drinking 

Please do not eat for six hours before the procedure. You can carry on drinking, but you should only drink clear fluids. Clear fluids include tea (no milk), coffee (no milk), squash, carbonated drinks, and water. 

Please do not drink for four hours before the procedure. You can have sips of water up to two hours before the procedure but nothing at all after this time. 

Medication 

If you are taking any blood thinning medications such as warfarin, clopidogrel, rivaroxaban, apixaban or any others, you should continue these unless we give you specific instructions about stopping them.

If you are diabetic and take insulin, it is important that you continue taking your insulin but it is suggested that you reduce your doses on the night before and on the day of the test. If you take diabetic tablets, please do not take them on the day of the endoscopy until after it has been done. 

Please continue taking acid reducing medications such as omeprazole and lansoprazole unless you are told to stop them. Please take any other medications as usual.

Please wear loose-fitting clothing when you come for your procedure. 

Please bring a list of all the medications you are currently taking. 

Please do not bring any valuables to the hospital as we cannot accept responsibility for any loss or damage. 

Please go to the Outpatient Department on the first floor of University College Hospital. Staff will direct you to the clinic waiting area. We will take a brief medical history, note any medications, and explain the procedure. We will take your pulse and blood pressure. You will then be asked to give your consent for the procedure.

We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves. Staff will explain all the risks, benefits, and alternatives before they ask you to sign a consent form. If you are unsure about any aspect of your proposed treatment, please speak with a senior member of staff again.

We will spray local anaesthetic on the inside of your nose to numb your nose and the back of your throat. We may ask you to drink sips of water with medicine to help clear any bubbles or mucous from your oesophagus or stomach so that there is a clear view. 

We will put a monitor on one of your fingers which records your heart rate and breathing. 

The camera will then be passed into your nose, down the oesophagus, into your stomach and then into the small bowel. The camera will take pictures which staff can look at on a screen next to you. You will be able to watch the procedure on the screen as well if you wish. We may take photographs during the procedure which will be attached to the procedure report. 

Air is put into your stomach so that there is a clear view of the lining of the organs. This may make you feel bloated during or after the test but will usually go away on its own. 

The procedure usually takes around five minutes, but it may take longer if tissues samples are taken. Taking tissue samples is painless and you will not feel it being done.

After your procedure we will explain what we have found and what will happen next. We will give you a copy of the procedure report and this will also be sent to your GP. You will then be escorted back to the waiting area and will be able to go home immediately.

If tissues samples are taken, it can take one to two weeks for them to be reviewed in the laboratory. We will write to you with the results or discuss them with you at your next outpatient appointment.

You can take your regular mediations as normal unless we give you different advice.

You should wait until the numb feeling from the anaesthetic spray has worn off before eating and drinking. You will receive an advice sheet with details of who to contact if you have any problems or difficulties.

If you experience any of the symptoms below please contact us immediately (see contact information below) or go to your local Emergency Department, informing them that you have had a transnasal endoscopy:

• Persistent vomiting 
• High temperature or a fever 
• Nose bleed, passing blood or vomiting blood 

Endoscopy Booking Team (Monday to Friday 09:00-17:00)
Direct line: 020 3456 7022 
Switchboard: 08451 555 000 / 020 3456 7890 ext. 67022
E-mail: uclh.endoscopy@nhs.net 

Endoscopy Recovery (Monday to Friday 09:00-17:00)
Direct line: 020 3447 3282 
Switchboard: 08451 555 000 / 020 3456 7890 ext. 73282 

On-call Gastroenterology Registrar (out of hours emergencies only) 
Switchboard: 08451 555 000 / 08451 555 000

Address: Outpatient Department, University College Hospital, 1st Floor Podium, 235 Euston Road, London, NW1 2BU