Impact of introducing transnasal endoscopy on expanding diagnostic endoscopy services
Introduction Demand for endoscopic services is outstripping capacity in the UK. Transnasal endoscopy (TNE) utilises a narrow calibre endoscope to pass through the nasal passages, thereby reducing retching and discomfort. It is better tolerated compared with standard transoral endoscopy (TOE) but is...
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| Format: | Article |
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/14/1/e002992.full |
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| author | Nigel Trudgill Hasan Haboubi Jeff Turner Laura Munglani Tom Crosby Ben Thomas Crosby Karen Wright Kay Charles Wendy Evans Megan Mathias Stevie Davies Badr Abdalla |
| author_facet | Nigel Trudgill Hasan Haboubi Jeff Turner Laura Munglani Tom Crosby Ben Thomas Crosby Karen Wright Kay Charles Wendy Evans Megan Mathias Stevie Davies Badr Abdalla |
| author_sort | Nigel Trudgill |
| collection | DOAJ |
| description | Introduction Demand for endoscopic services is outstripping capacity in the UK. Transnasal endoscopy (TNE) utilises a narrow calibre endoscope to pass through the nasal passages, thereby reducing retching and discomfort. It is better tolerated compared with standard transoral endoscopy (TOE) but is still rarely used as a diagnostic modality. There is still uncertainty about how well it performs against TOE in diagnostic ability, cost and efficiency.Methods We explored utilising TNE to deal with the growing demand for endoscopy. We compared findings to TOE procedures undertaken during the same time period. We evaluated cost differences, duration/time in the department for procedures as well as quality of procedures (both in terms of performance indicators as well as image quality using the validated POLPREP score).Results A total of 241 upper gastrointestinal endoscopy procedures were evaluated (100 TNE and 141 matched TOE) between December 2021 and February 2022. TNE outperformed TOE in obtaining >95% success rate in nationally approved key performance indicators (retroflexion and duodenal intubation, both p=0.026). It also was associated with better image quality in the oesophagus with a POLPREP A3 Score (excellent image quality) in 36/98 available images compared with 26/136 TOE (p=0.028) and was equivalent to TOE in the stomach and duodenum. TNE was identified as having a key role in facilitating complex cases, previously failed via the TOE route with a success rate in 11/12 (91.7%) of such cases. TNE also shows promise in correcting misdiagnoses of short-segment Barrett’s oesophagus (39%) compared with TOE (14.8%) (p=0.087).Conclusion TNE is an emerging endoscopic modality, which shows great promise in replacing TOE in most diagnostic circumstances. In a modern healthcare service, TNE is cheaper, better tolerated and outperforms TOE in multiple domains. |
| format | Article |
| id | doaj-art-706930443c044ed3afd5e2226fa3256f |
| institution | Kabale University |
| issn | 2399-6641 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj-art-706930443c044ed3afd5e2226fa3256f2025-02-03T20:05:10ZengBMJ Publishing GroupBMJ Open Quality2399-66412025-01-0114110.1136/bmjoq-2024-002992Impact of introducing transnasal endoscopy on expanding diagnostic endoscopy servicesNigel Trudgill0Hasan Haboubi1Jeff Turner2Laura Munglani3Tom Crosby4Ben Thomas Crosby5Karen Wright6Kay Charles7Wendy Evans8Megan Mathias9Stevie Davies10Badr Abdalla11Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UKDepartment of Gastroenterology, University Hospital Llandough, Llandough, South Glamorgan, UKDepartment of Gastroenterology, University Hospital Llandough, Llandough, South Glamorgan, UKCwmbran, The Grange University Hospital, Cwmbran, Wales, UKVelindre Cancer Centre, Cardiff, UKVelindre Cancer Centre, Cardiff, UKDepartment of Gastroenterology, University Hospital Llandough, Llandough, South Glamorgan, UKDepartment of Gastroenterology, University Hospital Llandough, Llandough, South Glamorgan, UKMoondance Cancer Initiative, Cardiff, UKMoondance Cancer Initiative, Cardiff, UKYsbyty Glan Clwyd, Rhyl, Denbighshire, UKDepartment of Gastroenterology, University Hospital Llandough, Llandough, South Glamorgan, UKIntroduction Demand for endoscopic services is outstripping capacity in the UK. Transnasal endoscopy (TNE) utilises a narrow calibre endoscope to pass through the nasal passages, thereby reducing retching and discomfort. It is better tolerated compared with standard transoral endoscopy (TOE) but is still rarely used as a diagnostic modality. There is still uncertainty about how well it performs against TOE in diagnostic ability, cost and efficiency.Methods We explored utilising TNE to deal with the growing demand for endoscopy. We compared findings to TOE procedures undertaken during the same time period. We evaluated cost differences, duration/time in the department for procedures as well as quality of procedures (both in terms of performance indicators as well as image quality using the validated POLPREP score).Results A total of 241 upper gastrointestinal endoscopy procedures were evaluated (100 TNE and 141 matched TOE) between December 2021 and February 2022. TNE outperformed TOE in obtaining >95% success rate in nationally approved key performance indicators (retroflexion and duodenal intubation, both p=0.026). It also was associated with better image quality in the oesophagus with a POLPREP A3 Score (excellent image quality) in 36/98 available images compared with 26/136 TOE (p=0.028) and was equivalent to TOE in the stomach and duodenum. TNE was identified as having a key role in facilitating complex cases, previously failed via the TOE route with a success rate in 11/12 (91.7%) of such cases. TNE also shows promise in correcting misdiagnoses of short-segment Barrett’s oesophagus (39%) compared with TOE (14.8%) (p=0.087).Conclusion TNE is an emerging endoscopic modality, which shows great promise in replacing TOE in most diagnostic circumstances. In a modern healthcare service, TNE is cheaper, better tolerated and outperforms TOE in multiple domains.https://bmjopenquality.bmj.com/content/14/1/e002992.full |
| spellingShingle | Nigel Trudgill Hasan Haboubi Jeff Turner Laura Munglani Tom Crosby Ben Thomas Crosby Karen Wright Kay Charles Wendy Evans Megan Mathias Stevie Davies Badr Abdalla Impact of introducing transnasal endoscopy on expanding diagnostic endoscopy services BMJ Open Quality |
| title | Impact of introducing transnasal endoscopy on expanding diagnostic endoscopy services |
| title_full | Impact of introducing transnasal endoscopy on expanding diagnostic endoscopy services |
| title_fullStr | Impact of introducing transnasal endoscopy on expanding diagnostic endoscopy services |
| title_full_unstemmed | Impact of introducing transnasal endoscopy on expanding diagnostic endoscopy services |
| title_short | Impact of introducing transnasal endoscopy on expanding diagnostic endoscopy services |
| title_sort | impact of introducing transnasal endoscopy on expanding diagnostic endoscopy services |
| url | https://bmjopenquality.bmj.com/content/14/1/e002992.full |
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