Overview

A transnasal endoscopy (TNE) looks at the foodpipe (oesophagus), stomach and small intestine. A thin flexible tube called an endoscope is passed through your nose and down the back of your throat. 

Your doctor or specialist nurse might recommend that you have a TNE to find out the cause of symptoms, such as:

• pain in your upper tummy (abdomen)
• difficulty swallowing
• recurring indigestion or heartburn
• being sick (vomiting)
• bleeding

This procedure is done by a specially trained doctor or nurse, called an endoscopist. It's possible to take a small tissue sample (biopsies) through the endoscope for review in the laboratory if this is needed.

A TNE can also help to diagnose:

• ulcers
• inflammation
• infection
• the presence of bacteria that can cause ulcers, gastritis and gastric cancer (helicobacter pylori)
• cause of anaemia
• coeliac disease (inability to digest gluten)
• cancer

You might also have a TNE to monitor a long-term health condition. Or, it can be used to check previously diagnosed conditions such as an ulcer or Barrett's oesophagus. 

Preparing for a TNE

Your stomach must be completely empty before your TNE. This is to make sure the endoscopist has a clear view, and so you do not vomit.

You must not eat any solid food for at least 6 hours before the test.

You can take small sips of water up to 2 hours before your appointment.

If you do not follow these instructions, your TNE will be cancelled and rebooked for another day.

You do not need someone to take you home on the day of the procedure.

Your medicines

You should have had a chance to tell a nurse or doctor about any medicines you take before your procedure. If you take anti-platelet medicine,  anticoagulant medicine to prevent blood clots (for example, aspirin, clopidogrel, warfarin, rivaroxaban, dabigatran), or medicine for diabetes, please speak to your doctor or call us before your appointment.

You should take all of your other medicines as usual, unless you have been told otherwise by the doctor or endoscopy nurse.

You might be told to stop taking medicines that reduce stomach acid (such as omeprazole, esomeprazole, lanzoprazole, pantoprazole). If you do need to stop these medicines, you will need to stop them 2 weeks before your procedure.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to have this procedure, we ask you to sign a consent form. This says that you agree to have the treatment and understand what it involves.

If you would like more information about our consent process, please speak to a member of staff caring for you.

Arriving at the hospital

When you arrive at the hospital, you will be seen by a nurse who will ask you about your medical history, and ask you to complete a health questionnaire. 

You can also talk to the nurses on the day if you have concerns about allergies or reactions.

You do not need to get changed for the procedure, but we might ask you to put a gown on over your clothes to protect them.

Once you are ready you will be taken to a waiting area. Your endoscopist will explain more about the procedure and answer any questions you have.

Delays to your appointment

We also deal with emergencies in the department. These can take priority over your appointment, so we might have to ask you to wait. We apologise in advance if this happens, but please be patient with us and check at the reception desk if you are concerned.

What happens during a TNE

A nurse will take you to the procedure room. You might be asked to remove your dentures, if you have them.

We spray a local anaesthetic into your nose 3 to 4 times. We do this about 10 minutes before the examination. The spray numbs your upper airways and makes the nostrils larger. This helps when the endoscope tube is being put in. We do not use any sedation or general anaesthetic. 

We ask you to lie down on your left-hand side on the bed. The endoscope tube will be gently put through your nose. If there is too much saliva in your mouth, it will be cleared with a sucker.

The endoscope tube used for a TNE is thinner than your little finger. It will not get in the way of your breathing at any time, as it passes down your oesophagus and not your windpipe. You can breathe and talk normally during the procedure.

A nurse will stay with you during the examination. You can ask to stop the procedure at any time by saying so or raising your hand.

The endoscopist might pass some air down the endoscope to get a clearer view. This might make you feel slightly bloated, but it should not be painful.

The procedure usually lasts 5 to 15 minutes. When it is finished, the endoscope will be removed quickly and painlessly. 

Taking a tissue sample (biopsy)

Sometimes a small tissue sample (a biopsy) will be taken for analysis in the laboratory. The tissue is removed through the endoscope using tiny forceps (scissors). Sometimes this can be uncomfortable, but the discomfort should pass quickly. You will probably only feel a tugging sensation.

Photographs might be taken, but that does not mean there is something wrong.

Putting the endoscope through your mouth

If it is not possible to pass the endoscope through your nose, we might ask you if we can try putting the endoscope through your mouth (transoral endoscopy or OGD). This will be done with sedation to help you relax, and your nurse will give you a new appointment.

If you cannot tolerate the endoscopy, other options will be discussed with you.

After a TNE

After the procedure, you will be taken to the recovery area. Once your nurses are sure there is no bleeding or discomfort, you will be able to leave hospital (discharged). This waiting time is usually 10 to 15 minutes.

The results of the procedure will be discussed with you on the day. One of the following will happen.

• You might be discharged back to your GP.
• You might need a follow-up appointment in clinic, which you will be sent a letter for.
• The clinical team might review your results and discuss your care. You and your GP will receive a letter about the next steps of your treatment 4 to 6 weeks after your procedure.

A copy of the report and a discharge information sheet will also be given to you.

After you leave hospital

You can do your usual day-to-day activities and eat and drink once the local anaesthetic spray has worn off.

Risks of a TNE

A TNE is a safe test. The most common side effects are having a sore nose or nose bleed. These side effects usually settle down on their own.

Serious complications are rare, but sometimes the endoscope can damage the lining of the oesophagus, stomach or intestine. If this happens, it can cause:

• bleeding (1 in 5,000 people)
• infection
• a tear in the oesophagus, stomach or intestine (1 in 10,000 people)

If this happens to you, you might need to have a blood transfusion, stay or come into hospital, or have surgery to treat the problem.

There is also a risk of chest infection due to aspiration, which is when fluid from the stomach goes into the lungs. If you get a chest infection, you will need antibiotics. This is a small risk.

You might be allergic to the local anaesthetic spray. You should contact your nursing team before your procedure if you know you are allergic to lidocaine, lignocaine or phenylephrine.

Your doctor or specialist nurse will discuss the possible complications with you before you sign the consent form. They will also talk to you about other examinations you can have if you do not have a TNE.

Other examination options

Transoral endoscopy

This procedure is like a transnasal endoscopy (TNE), but the endoscopy tube is put through your mouth, not your nose. A TNE is more comfortable than a transoral endoscopy, as gagging is rare and you can talk during the procedure to let us know of any discomfort.

As the TNE does not involve sedation, you will also have a faster recovery time and you do not need anyone to travel home with you.

Barium test

Another option is to have a barium meal. This involves having an X-ray after drinking some barium liquid. You might still need an endoscopy if the X-ray shows anything unusual.

A barium test involves radiation and is less accurate than an endoscopy. Biopsies of the gut or polyps cannot be taken during a barium test, so you might still need a transnasal or transoral endoscopy after a barium test.