Please be aware, the information on this page relates to Luton & Dunstable University Hospital

Transnasal Endoscopy Information Leaflet

This information leaflet is for patients who are having a Transnasal Endoscopy.

A Transnasal Endoscopy (TNE) looks at the food pipe (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 is possible to take small tissue samples (biopsies) through the endoscope for review in the laboratory if this is needed.

Reasons for having this examination

Diagnostic

So that the doctor or nurse specialist can see any abnormalities

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

Investigative

Small samples (biopsies) can be taken from the lining of the oesophagus, stomach or duodenum for laboratory tests.

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.

Preparation for the examination

For this examination to be successful, the stomach must be as empty as possible.  It is important to have had nothing to eat for 6 hours before the test but you can have sips of clear fluids up until 2 hours before your appointment.

Please note milk is not a clear fluid and should not be taken 6 hours prior to your test.

If you have an afternoon appointment for your TNE procedure, please have a light breakfast only, no later than 6 hours prior to the procedure.

Please read and complete your medical assessment form in advance of your procedure.

We want to involve you in decisions about your care and treatment.  If you decide to have this procedure we will ask you to sign a consent form.  This says that you agree to have the treatment and understand what it involves.  The consent form will be sent to you and a nurse will discuss this with you on the day.

Contact us if you have had any reactions or allergies to other examinations in the past.

Wear loose fitting clothes around your neck on the day of the test.

Your medicines

You should have had a chance to tell a nurse or doctor about any medicines you take before your procedure.

If you have diabetes, or you are taking anti-platelet medicine, or anticoagulants (blood thinning medication) such as Warfarin, Clopidogrel, Ticagrelor, Dabigatran, Rivaroxaban, Edoxaban or Apixaban, you will be given specific instructions in advance.  Patients who continue to take Warfarin, or who have stopped Warfarin just before the test, will need to have a finger prick blood test on the day, in the Unit.

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

You might be told to stop taking medicines that reduce stomach acid (such as Omeprazole, Esomeprazole, Lansoprazole and Pantoprazole).  If you do need to stop these medicines, you will need to stop them 2 weeks before your procedure.

On arrival at the hospital

  • Please go straight to the Endoscopy Unit and ring the bell to let the staff know you have arrived;
  • Procedure times can be unpredictable so you may have to wait a while, it is a good idea to bring something to read;
  • 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;
  • A nurse will discuss your medical history with you, while also checking your pulse, blood pressure, oxygen levels, blood sugar (if diabetic) and clotting (if on anticoagulants).  You will be asked any necessary additional questions and you will have the opportunity to ask anything you may want to know;
  • The nurse will discuss your consent form with you, to confirm that you understand the procedure and agree to go ahead with it, and the form should be signed;
  • Before the test is started you will be asked to remove dentures, spectacles and contact lenses;
  • You do not need to undress but should remove your coat or jacket.  You will then wait in the reception area until you are taken through to the examination room; and
  • A nurse will remain with you throughout the examination

The examination

A nurse will take you to the procedure room.

We spray a local anesthetic 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 anesthetic.

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 you 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 (Trans oral endoscopy or OGD).

After the examination

After your procedure, you will be taken to the recovery area.

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.

Individuals are unable to donate blood for 4-6 months following any endoscopic procedure.

Going home

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

You may feel a little bloated from some air left in the stomach.  This will pass and you should not need to take any medicine.

Please contact your GP or go to your nearest emergency department (A&E) if:

  • You develop severe tummy (abdominal) pain;
  • You have a fever;
  • You are being sick (vomiting);
  • You are passing large amounts of blood after the test

Please take your Endoscopy report with you.

The risks

A TNE is a safe test.  The most common side effects are having a sore nose or nosebleed.  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 the TNE.

Sleep Apnoea

Please bring your CPAP machine with you for your appointment.

Pacemaker Device or Implantable Cardioverter Defibrillator (ICD)

Please bring your pacemaker device or implantable cardioverter defibrillator manufacture information card with you, as a cardiac technician may be required to check your device and will need that information to make sure your device is safe for you during the procedure.

Further information

If you have any concerns about these risks, please speak to your Consultant or Specialist Nurse

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