HJAR May/Jun 2025

36 MAY / JUN 2025 I  HEALTHCARE JOURNAL OF ARKANSAS ADH CORNER COLUMN CHILDREN’S HEALTH What Is Transnasal Endoscopy? Transnasal endoscopy involves introducing an ultra-thin flexible endoscope through the patient’s nose rather than the mouth. Because of the slim caliber of the instrument, often 2.8 to 4.2 mm in outer diameter, the procedure can be performed while the patient is awake, using topical lidocaine to numb the nasal passages and pharynx. For pediatric patients, distraction methods, such as virtual reality goggles, can ease anxiety and improve patient cooperation during the procedure. Indications for TNE in Children In children, TNE is primarily used to evaluate and monitor esophageal conditions. Common indications include: • Eosinophilic esophagitis (EoE): EoE is an allergic immune response of the esophagus to allergens, where chronic injury and inflammation lead to scarring and narrowing of the esophagus. Children with EoE often need multiple endoscopies to monitor disease activity and treatment response, specifically after tweaking medical treatment and implementing dietary restrictions based on allergies. • Dysphagia and food refusal or feeding difficulties: TNE can assess structural (strictures or narrowing) and mucosal abnormalities, like ulcers and polyps, in children who have difficulty swallowing or are vomiting frequently due to underlying chronic gastroesophageal reflux disease (GERD) or EoE. • Inflammatory and infectious esophagitis: Fungal infections (like Candida esophagitis) after frequent antibiotic or steroid use or herpes viral infections can be evaluated with TNE. • Other gastrointestinal complaints: Some centers also use TNE to help diagnose Sulaiman Bharwani, MD Pediatric Gastroenterologist Arkansas Children’s Transnasal endoscopy (TNE) is emerging as an innovative, minimally invasive alternative to conventional esophagogastroduodenoscopy (EGD) under sedation. TNE is particularly beneficial for children who require repeated evaluations for conditions like eosinophilic esophagitis (EoE) and other esophageal disorders. TRANSNASAL ENDOSCOPY: A Game-Changer in Esophageal Evaluation of Children with Upper GI Symptoms