Normal transnasal esophagoscopy.

New diagnostic technology has become available that allows otolaryngologists to perform in-office transnasal esophagoscopy (TNE) without the need for intravenous or oral anesthesia or analgesia. The new esophagoscopes are narrow enough (5.1 mm) to pass through the nose, and they provide essentially the same patient safety and comfort levels as do transnasal fiberoptic laryngoscopes. In addition, these esophagoscopes can be used to perform air insufflation and obtain biopsy specimens.

TNE is performed while the patient sits upright in the office chair. The patient is first administered topical anesthesia and a topical decongestant (figure). The nasal cavity is sprayed with 1:1 oxymetazoline 0.05% and lidocaine 4%. The patient is also given 2 benzonatate perles and instructed to keep them in the back of the oropharynx until they completely dissolve. Next, the otolaryngologist administers 2 sprays of 20% benzocaine to the oropharynx. The endoscope is also lubricated with 2% viscous lidocaine.

The otolaryngologist can then pass the scope through the nasal cavity and visualize the entire upper aerodigestive tract, from the nasal vestibule to the gastroesophageal junction (figure). TNE is particularly useful for examining patients who have reflux disease, swallowing disorders, strictures, and other esophageal pathologies.