Office-based esophagoscopy: A preliminary report

OBJECTIVE: Preliminary study that describes unsedated, transnasal esophagoscopy (TNE) in an office setting. STUDY DESIGN AND SETTING: TNE was prospectively performed on 14 consecutive out-patients with dysphagia whose initial oropharyngeal dysphagia evaluation was insufficient to reveal the cause of their swallowing problem. TNE was carried out without conscious sedation while the patients were sitting in an examining chair. Ease of endoscope insertion, optical quality of images, and examination findings were assessed. Heart rate before and after the procedure and incidence of epistaxis and airway compromise was also determined. Patients were asked to rate the level of discomfort of TNE on a validated 10-point scale (1 representing none/well tolerated and 10 severe/poorly tolerated). RESULTS. All patients completed TNE with the esophagus readily intubated and esophageal mucosa clearly visualized. Findings included esophageal stricture, patulous upper esophageal sphincter, and Zenker's diverticulum. There were no incidences of epistaxis or airway compromise and no significant changes in heart rate. Overall tolerance of TNE was rated by the patients as 2.0 (SD, 1.2). CONCLUSIONS: TNE is well tolerated and can be safely performed in patients with dysphagia in an office setting. TNE may have a role in the comprehensive evaluation of the dysphagic patient in the office.