Abstract
[Objective]We examined methods of introducing transnasal endoscopes in endoscopic screening for gastric cancer, and we studied the rate of improvement of the vomiting reflex and the level of pain, the occurrence of epistaxis after the patient returned home, and the safety of these methods in screening. [Methods]The transnasal endoscope used was the Olympus GIF-N260 (2-mm instrument channel; external diameter: 4.9 mm at the tip and 5.2 mm at the flexible portion). We classified the extent of a subject's vomiting reflex in a previous endoscopic exam with a normal endoscope using a 5-point scale; in principle, we recommended transnasal insertion for individuals with a score of 4 or higher and nasal illnesses (-), and we examined the rate of improvement in the vomiting reflex. We also conducted a questionnaire survey (anonymous, sent by mail). [Results]In 167 cases in which a transnasal endoscope was indicated (7.3% of the total), the insertion success rate was 91% (152 cases); the insertion rate was lower in women. In addition, the exam time was significantly longer for transnasal endoscopy than for endoscopy with a scope of normal diameter. Three cases of epistaxis (1.8%) were noted, but bleeding was immediately stopped in all cases. With transnasal endoscopy, the vomiting reflex improved significantly, and alleviation of pain was also indicated in the questionnaire survey. Discomfort in the nasal cavity did not persist, and epistaxis after the patient returned home was minimal. [Conclusion]The acceptance and safety of transnasal endoscopy are minimum prerequisites for endoscopic screening. Introduction of such endoscopy in gastric cancer screening will increase the use of endoscopy and is expected to be linked to an improvement of the cancer detection rate. The method of introduction may be determined after selecting relatively young patients with a strong vomiting reflex, but there are problems in terms of image quality and maneuverability, so final instrument selection should be appropriately decided by the endoscopist in consultation with the patient.
