Transnasal Endoscopy Eliminates Need for Anesthesia for Children and Teens With Eosinophilic Esophagitis (EoE)
From left, Katharine Newton, Richard Best and John Lyles, MD, celebrate Duke Health’s first transnasal endoscopy.
To diagnose and treat his eosinophilic esophagitis (EoE), Richard Best, 15, has undergone multiple endoscopies -- procedures in which a narrow, flexible tube with a light and small video camera is inserted through the mouth and fed down the esophagus. Endoscopies usually require sedation, along with the inherent risks of anesthesia and more time in the hospital. In May 2024, Richard became Duke Health’s first patient to undergo a transnasal endoscopy, in which the scope is fed through the nose. No anesthesia was required, and he returned to his normal activities that same day.
Growing up, Richard was beset by recurrent episodes of croup, an infection that causes a narrowing of the upper airway, making it harder to breathe. “Sometimes he would wake up with a barking cough, like a seal, and we would have to go to the emergency room for breathing treatments, steroids, or both,” said his mom, Jennifer Best.
In March 2019, Richard was diagnosed at Duke Health with eosinophilic esophagitis, a chronic inflammatory condition of the esophagus that can lead to difficulty swallowing, heartburn, stomach pain, vomiting, or even growth problems. Treatments include elimination diets and medications. Once treatment is started or changed, specialists perform an endoscopy to assess how well the treatment or change in treatment has worked. Altogether, Richard had eight endoscopies performed at Duke under sedation as his medical team worked to find the right treatment for his EoE.
An Innovative Approach to Endoscopy
In May 2024, when it was time for his ninth endoscopy, Richard's pediatric gastroenterologist, Duke’s John L. Lyles MD, suggested a newer procedure -- a transnasal endoscopy -- during which the endoscope would be fed down his nose into his esophagus while Richard remained awake.
According to Dr. Lyles, the transnasal endoscopy has multiple benefits to patients and their families. “The most obvious one is that you can avoid anesthesia,” he said. “Repeated sessions of anesthesia increase its risks, and can be challenging in people with chronic lung disease or asthma. Families also generally spend less time in the hospital. For instance, if you’re getting an upper endoscopy with anesthesia, you’re going to be in the pre-operating room for at least an hour and a half before the procedure, and then anywhere between 30 and 60 minutes to wake up.”
Relieving Anxiety During Endoscopy
Richard was game. “He was nervous because he didn’t know how he would feel about being awake with something going in his nose,” said Jennifer Best. “But the staff was absolutely wonderful. They talked him through everything and made sure he was comfortable throughout the whole procedure.”
“We set kids up with virtual reality goggles so they’re distracted during the procedure,” said Dr. Lyles. “I walk them through it like, ‘Hey, I'm going into your nose, now we're going to the back of your throat, or going into your esophagus.’ The kids probably feel some sensations to confirm it, but they don't see me doing it. I can relieve some anxiety, some sort of self-protective mechanisms that might otherwise cause them to turn away.”
“It took maybe 15 minutes and he was done,” said Jennifer Best. “Whereas when he had the standard endoscopies, it was just a long drawn-out thing.”
“The results of Richard’s endoscopy were great,” said Dr. Lyles. “His EoE is in remission on this current treatment plan, so he won't need to come back unless he has issues arise for another year. He did really well with transnasal endoscopy, and I think he will be a great candidate for it again in the future.”
