Nasal vs. Oral Gastroscopy

Gastroscopy: Nasal vs. Oral - Which Examination is Best for You?

What is a Gastroscopy?

A Gastroscopy is an endoscopic examination of the oesophagus, stomach, and duodenum, used to diagnose the cause of gastrointestinal symptoms such as abdominal pain, difficulty swallowing, or reflux.

The examination is performed using a flexible, thin endoscope (gastroscope). At Kirurgen.dk, we primarily offer two methods:

1. Oral Gastroscopy (TOE): The scope is inserted through the mouth.
2. Nasal Gastroscopy (TNE): The scope is inserted through the nose.

This blog post compares the two methods to provide you with the best basis for decision-making before your examination.

Nasal Gastroscopy: Best for Patient Comfort and Anxiety

Nasal Gastroscopy (TNE) has become a popular alternative to the traditional method, primarily due to improved patient comfort.

• Ultra-thin Scope: The endoscope is significantly thinner (only approx. 4-6 mm), equivalent to a thin straw.
• Minimal Gag Reflex: The scope avoids touching the tongue and the sensitive areas of the throat, minimising discomfort and the sensation of vomiting (gag reflex).
• Unobstructed Breathing and Communication: You can breathe normally through your mouth and can often speak and answer the doctor's questions during the examination.
• Rapid Normalisation: In many cases, you can eat and drink as soon as 20-30 minutes after the examination, as no anaesthetic spray has been used in the throat.
• Best suited for: Standard diagnostic examinations where standard tissue samples (biopsies) need to be taken.

Oral Gastroscopy: The Standard Method for Therapeutic Interventions

Oral Gastroscopy (TOE) is the classic standard method. Although it is associated with more discomfort, it is often necessary for technical reasons.

• Larger Scope: The endoscope is thicker (approx. 8-10 mm), equivalent to a pinky finger.
• Larger Working Channel: The primary advantage is that the thicker scope has a larger internal working channel. This channel is crucial for the insertion of larger surgical instruments.
• Best for Therapeutic Treatment: Oral Gastroscopy is preferred when the doctor expects to perform more complex interventions. These may include:
  • Removal of large polyps.
  • Stopping severe bleeding in the stomach.
  • Dilation of narrowing (strictures) in the oesophagus.
• Better Image Quality: Although the gap is narrowing, the larger scope often provides a wider field of view and higher image quality for detailed inspection.
• Best suited for: Examinations where major interventions and treatment are expected to be necessary.

Overview: Which method should I choose?

Aspect	Oral Gastroscopy (TOE)	Nasal Gastroscopy (TNE)
Scope Size	Approx. 10 mm (Larger)	Approx. 4-6 mm (Ultra-thin)
Gag Reflex	High risk	Low risk
Speech/Breathing	Speaking not possible, breathing may feel strained	Speaking possible, unobstructed breathing
Need for Sedation	Often necessary	Less often necessary
Therapeutic Interventions	Yes, preferred method (larger polyps, bleeding)	No, limited to diagnostics and small biopsies

Remember: Your doctor is best placed to assess which method suits your specific symptoms and anatomy.

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References

• On patient acceptance and safety in transnasal vs. oral gastroscopy (2008):
  • Title: Unsedated transnasal versus transoral sedated upper gastrointestinal endoscopy: A one-series prospective study on safety and patient acceptability.
  • Journal: Digestive and Liver Disease, May 2008.
• On patient tolerance in unsedated transnasal vs. conventional oral endoscopy (2014):
  • Title: Unsedated transnasal versus conventional oral endoscopy in endoscopy naïve patients.
  • Journal: Acta Gastroenterologica Belgica, June 2014.
• On clinical findings and national guidelines for gastroscopy (2011):
  • Title: Clinical findings confirm national guidelines regarding primary gastroscopy for upper gastrointestinal symptoms.
  • Journal: Danish Medical Journal, 1 May 2011.