Transnasal Endoscopy for Eosinophilic Esophagitis in Children

Transnasal endoscopy (TNE), also called transnasal esophagoscopy, is a safe, quick, nonsurgical procedure in which a thin tube (between 1/8 inch and 1/4 inch in diameter) with a camera at one end is passed through the nose to examine the esophagus. The procedure is performed after the patient’s nose and throat have been numbed. Through its Pediatric Gastroenterology, Hepatology, and Nutrition division, University Hospitals Rainbow Babies & Children’s Hospital was the first hospital in Ohio and fourth in the country to offer the procedure for use in management of Eosinophilic Esophagitis (EoE) – an inflammation of the esophagus triggered by food allergens – in children. Presently, UH Rainbow Babies & Children’s is the only hospital in Northeast Ohio to offer the service.

As changes are made to their diets to discover what foods are causing their EoE, pediatric patients often require repeated studies, typically every six to twelve weeks until the allergen is identified. Traditionally, these tests have been regular upper endoscopies. Unlike regular upper endoscopies, TNEs do not require the use of anesthesia or deep sedation. Other benefits of TNE over regular upper endoscopy include:

• Shorter outpatient stays. The entire patient stay typically takes 30 – 45 minutes from the time of hospital admittance to discharge, whereas regular upper endoscopies can take between three and four hours.
• Less invasive procedure. Unlike regular upper endoscopies performed under anesthesia, TNEs do not require IV placement.
• Use of distraction methods. Children can watch TV or wear VR goggles during the procedure.
• Parental presence. Parents can be present for the entire procedure.
• Reduced fasting period. The period of time in which your child may not eat anything is about two hours prior to the procedure versus eight hours for a regular upper endoscopy.
• Lower cost: TNEs cost between 35 percent and 50 percent of the cost of regular upper endoscopies.

EoE patients may go to school, participate in sports or drive home (if they are old enough) as soon as they are done with the TNE. As such, we can schedule the procedure as early as 7 a.m. to allow you and your child to get back to your day as quickly as possible. If you suspect your child may have EoE, be sure to make an appointment with your pediatrician. Warning signs of EoE include:

• Frequent vomiting
• Problems gaining weight
• Refusal to eat
• Sensation of food getting stuck in the throat when swallowing