Pediatric unsedated transnasal endoscopy (TNE)

What is a pediatric unsedated transnasal endoscopy (TNE)?

Unsedated transnasal endoscopy (TNE) is a test doctors use to see inside the stomach and food pipe (the esophagus, which connects the mouth to the stomach). It can also be used to visualize the start of the small intestine. First, your child receives medicine to numb the nose and throat. Then, our doctor passes the endoscope (narrow tube with a camera) through your child’s nose and down their throat. We can examine the food pipe and stomach and take small tissue samples to examine under a microscope (biopsy).

Children can have unsedated TNE while they’re awake, unlike with traditional endoscopy, which requires medicine to put them in a sleep-like state (general anesthesia). At Children’s Health, we currently offer unsedated TNE for children with eosinophilic esophagitis (EoE) who need repeated endoscopy tests. We also offer it for other gastrointestinal (GI) conditions involving the esophagus and stomach including acid reflux and H. pylori infections.

What are the benefits of a pediatric unsedated transnasal endoscopy (TNE)?

Children who have EoE and other conditions affecting their food pipe/stomach often need a test called an upper endoscopy. With traditional endoscopy, children need general anesthesia to put them in a sleep-like state so they don’t feel pain or remember the procedure. That means fasting beforehand, a day at the hospital, and missed school and work for families.

Unsedated TNE makes endoscopy easier for children who need these tests regularly to monitor EoE. Compared with traditional endoscopy, unsedated TNE offers several benefits, including:

• Faster operative appointments (about 2 hours instead of 6 hours)
• No intravenous (IV) or other needles used
• No need for general anesthesia, increasing safety and reducing risks
• Lower risk of infection because the scope is used only once
• Shorter fasting time (2 to 4 hours instead of 6 to 8 hours) before the procedure
• No recovery time

What are the side effects of a pediatric unsedated transnasal endoscopy (TNE)?

Unsedated TNE may cause some discomfort in your child’s nose and throat for a few hours after the procedure. The pediatric gastroenterologists (doctors who specialize in diagnosing and treating conditions of the digestive tract) at Children’s Health have experience in providing unsedated TNE for children. To reduce your child’s discomfort, we apply numbing medicine inside their nose and on the back of their throat before the test. We also use the narrowest endoscopes available.

What are the risks of a pediatric unsedated transnasal endoscopy (TNE)?

Unsedated TNE carries possible risks, which are rare. Our gastroenterologists and their teams work carefully to help reduce the risks so that your child feels fine after the procedure.

These risks include:

• Bleeding from biopsy areas and hematoma formation
• Infection
• A hole (perforation) in the upper GI tract

What to expect with a pediatric unsedated transnasal endoscopy (TNE)

At Children’s Health, we offer unsedated TNE at our Pediatric Gastroenterology Lab, where our gastroenterologists perform more complex gastrointestinal procedures than any other program in North Texas.

What to expect before a pediatric unsedated transnasal endoscopy (TNE)

You and your child will need to arrive at the hospital about one hour before the appointment for unsedated TNE. Your child's doctors and nurses will explain everything you and your child need to know about TNE. You can also ask them any questions you may have.

On the day of the procedure, your child:

• Can take all their medicines as usual
• Should stop eating and drinking 2 to 4 hours before the appointment time

What to expect during a pediatric unsedated transnasal endoscopy (TNE)

Our doctor will put a nasal decongestant and a numbing medicine called lidocaine into your child’s nose and throat before inserting the endoscope. We’ll also give your child virtual reality goggles to help them relax and stay distracted during the procedure. Your child can choose to visit locations around the world through the goggles or watch other online content.

After your child’s nose and throat are numb, we’ll insert the endoscope through their nose and down their throat into the food pipe. We’ll quickly take any pictures and tissue samples we need. The procedure itself usually takes less than 10 minutes.

What to expect after a pediatric unsedated transnasal endoscopy (TNE)

You can take your child home or back to school after unsedated TNE. They can return to their usual activities and eat and drink as usual.

How do I prepare my child for a pediatric unsedated transnasal endoscopy (TNE)?

You can help prepare your child by talking to them about what will happen during the procedure. Let them know that the tube may feel a little uncomfortable but will only last for a few minutes. Tell them that they’ll get to play with virtual reality goggles during the entire procedure.

What questions should I ask my provider about a pediatric unsedated transnasal endoscopy (TNE)?

• Is my child a good candidate for unsedated TNE?
• Why does my child need unsedated TNE?