Fédération des spécialités digestives, pavillon Hbis, hôpital Edouard-Herriot, 5, place d’Arsonval, 69437 Lyon cedex 03, France
Transnasal gastroscopy is a better-tolerated alternative that has been made possible by the development of smaller endoscopes. The diameter of the endoscope is directly related to the success rate of the procedure. One plane bending 4.9 mm diameter pediatric endoscopes are now available. Transnasal gastroscopy is possible in more than 90% of the cases. Most frequent causes of failure are patient refusal, nasal pain and impossibility of crossing the nasal cavities. Female sex, age < 35 years and greater endoscope diameter (5.9 mm) are predictive factors of failure. Compared to standard gastroscopes, transnasal gastroscopes have a lower resolution and luminosity and weaker suctioning and air-inflation capabilities. Diagnostic performances of transnasal gastroscopy or gastroscopy with small diameter endoscope have not been assessed in methodologically appropriate studies. Biopsy samples are smaller with the biopsy forceps used with small caliber endoscopes, but they are as informative as the ones obtained using conventional forceps. Thanks to a better tolerance, transnasal gastroscopy should minimize the need for anesthetic procedures and sedation. This should lead to less complications and suppression of the costs of sedation and general anesthesia.