Chi-Tan Hu
Buddist Tzu Chi Hospital and Tzu Chi University, Taiwan
Title: Transnasal Endoscopy is not So Simple as You Can Imagine
Biography
Biography: Chi-Tan Hu
Abstract
An ultrathin endoscope was initially developed in the 1970s for the use in pediatric patients. In recent years, unsedated transnasal esophagogastroduodenoscopy (UT-EGD) has been used for diagnostic and therapeutic purposes such as percutaneous endoscopic gastrostomy, enteral tube placement, nasobiliary tube drainage and polypectomy. The satisfactory safety and tolerance profiles make UT-EGD an alternative to peroral conventional EGD with or without sedation. There is a trend toward performing transnasal laryngoscopy, transnasal esophagoscopy (especially for screening Barrett's esophagus) and UT-EGD in the office. However, many techniques related to UT-EGD are not standardized. Professor Hu proposed reporting the how, where, and grading of nasomucosal injury (grade 0, 1, 2 and 3) after transnasal endoscopy. He demonstrated that an endoscopic-guided method (EGNA) is better than the cotton-tippled applicator method (CTNA) of nasal anesthesia. Further, he revealed a cotton-tipped applicator primed gauze pledgetting (CTGP) method is more effective than EGNA. CTGP, which only needs a 5-min procedure, has achieved a painless nasal insertion and exertion. He has recently introduced anterior meatuscopy coupled with an endoscopic meatus scoring system (EMSS, grade 0, I, II and III), replacing sniff test to select an optimal meatus insertion route before UT-EGD. Documenting a meatus score is important because it may be correlated with the severity of nasomucosal injury and bleeding. In addition to the novel nasal anesthetic methodology, the techniques of endoscopic insertions from the anterior to posterior nasal cavities, nasopharynx to oropharynx, and hypopharynx to the esophagus will be demonstrated. He will also introduce techniques to avoid nasal bleeding and gag reflex.