Transnasal endoscopy for eosinophilic esophagitis surveillance in adolescents with mild autism spectrum disorder: A single-center case series.

Children with autism spectrum disorder (ASD) often experience sensory sensitivities and procedural anxiety, which can complicate sedated esophagogastroduodenoscopy (EGD). Transnasal endoscopy (TNE) is a less invasive, unsedated alternative, but data on its use in this population are limited. We evaluated the safety, tolerability, and clinical utility of sedation-free TNE in adolescents with Level 1 ASD (mild autism) undergoing surveillance for eosinophilic esophagitis (EoE). In this retrospective case series, five adolescents (mean age 13.2 years; 80% male) underwent TNE between April 2024 and April 2025. We assessed procedural success, adverse events, biopsy adequacy, and behavioral strategies. All procedures were completed successfully without sedation or serious adverse events. Child Life Specialists (CLSs) supported 80% of cases, using behavioral aids, such as virtual reality (VR) goggles and desensitization tools. Mean procedure time was 10.75 ± 1.96 min. We concluded that TNE is a safe and feasible alternative to sedated EGD in carefully selected adolescents with mild ASD and warrants further study in larger cohorts.