Exploring Patient Experience and Acceptability of Sedated Transnasal Endoscopy as an Alternative to Oesophagogastroduodenoscopy Under General Anaesthetic.

Objective  Demands on endoscopy services have increased substantially in recent years, exacerbated by the COVID-19 pandemic. Oesophagogastroduodenoscopy (OGD) under conscious sedation is poorly tolerated by a subgroup of patients, who are often referred for propofol-sedated or general anaesthetic OGD (GA OGD), a resource-intensive procedure associated with prolonged waiting times. Transnasal endoscopy (TNE) is better tolerated and has comparable diagnostic accuracy to conventional OGD. This study evaluated patient-reported experience of sedated TNE (sTNE) as an alternative to GA OGD. Method  Fourteen patients who were unable to tolerate OGD under conscious sedation were identified from the GA OGD waiting list and offered sTNE. Following the procedure, participants completed questionnaires comprising Likert-scale assessments of comfort, acceptability and willingness to recommend the procedure, together with optional free-text comments. Free-text responses underwent descriptive thematic analysis. Results  All 14 patients (100%) successfully completed sTNE despite previous intolerance of conventional OGD under conscious sedation. All participants reported the procedure to be comfortable and stated they would recommend it as an alternative to GA OGD. Among the 10 patients with previous OGD experience, all reported sTNE to be more tolerable than their prior procedure. Analysis of free-text responses demonstrated consistent findings, with 56.5% specifically highlighting good tolerability and 95.7% expressing an overall positive patient experience. Conclusion  Sedated TNE demonstrated excellent patient tolerability in individuals who had previously been unable to tolerate conventional OGD and enabled removal from the GA OGD waiting list. These findings support sTNE as a promising alternative for appropriately selected patients, with the potential to reduce waiting times and optimise endoscopy resource utilisation. Larger prospective studies are warranted to confirm these findings.