The safety, efficacy, and economic implications of using transnasal oesophagoscopy (TNE) are compared with conventional rigid or flexible oesophagoscopy for oesophageal disorders in otorhinolaryngology (ORL) clinics in this systematic review. Eleven electronic databases were searched for articles on transnasal oesophagoscopy. A total of 67 relevant titles were identified and 39 abstracts were screened of which 17 full- text articles were included in this report. There was fair level of evidence to suggest that TNE was effective for screening examination in patients with dysphagia, globus pharyngeus, and reflux symptoms and for detection of metachronous oesophageal carcinoma. TNE can also be used to biopsy suspicious lesions in the upper aerodigestive tract, placement of wireless pH capsule, transnasal balloon dilation of the oesophagus, secondary tracheoesophageal puncture, and management of foreign bodies. TNE was well tolerated and can be safely performed in an office setting with topical anaesthesia. Complications associated with TNE were mild and uncommon. There was evidence to suggest potential cost savings by performing TNE in the office setting compared with conventional investigation and examination for dysphagia. TNE may lead to a change in practice from investigation and treatment in the operating theatre or day care center to an office-based practice. 1. Introduction Oesophagoscopy and barium radiology represents the primary means by which structural diseases of the oesophagus are investigated. Until 1996, the oesophagoscopy performed by otolaryngologists had primarily been rigid endoscopy, performed transorally, with patients under general anaesthesia. Beginning mid 1990s, otolaryngologists began to perform oesophagoscopy utilizing an ultrathin, flexible scopes passed transnasally, with the patients not sedated, solely relying on topical anaesthesia. This approach is called transnasal oesophagoscopy (TNE) in the United States of America (USA), and it is known as transnasal flexible laryngooesophagoscopy (TNFLO) in the United Kingdom (UK). TNE is performed in the clinic without the sophisticated patient monitoring and skilled ancillary personnel that are required during and after rigid oesophagoscopy. It is performed with conscious sedation in the endoscopy suite or room. It is claimed to have the following advantages over conventional peroral, rigid, or flexible oesophagoscopy carried out in a sedated patient: enhanced patient safety, improved survival of oesophageal adenocarcinoma, increased practice efficiency, and costsaving [1].
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