HJAR May/Jun 2025

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2025 37 Hamza Hassan Khan, MD Pediatric Gastroenterologist Arkansas Children’s children can quickly return to school, and parents can return to work the same day. • Lower costs: Because TNE is performed in an outpatient setting and does not require anesthesia, fees and physician charges are notably lower than traditional EGD. Eosinophilic Esophagitis Eosinophilic esophagitis is a chronic, immune-mediated condition characterized by an accumulation of eosinophils — a type of white blood cell — in the esophageal mucosa lining. This inflammatory process can lead to symptoms such as: • Difficulty swallowing (dysphagia). • Food impaction. • Abdominal pain and recurrent vomiting. • Chronic nausea. • Food aversion. • Failure to thrive or malnutrition in children. Because EoE is a recurring condition, periodic endoscopic evaluations are essential for monitoring disease activity and documenting responses to therapeutic modifications. How TNE Enhances EoE Diagnosis and Management For children with EoE, repeated endoscopies are necessary to assess both visual and histologic changes in the esophageal mucosa during and after treatment. TNE offers several advantages in this context: • Frequent monitoring: Since TNE avoids the risks of sedation, it enables clinicians to perform serial evaluations more readily. • Biopsy integrity: Concerns about the adequacy of tissue samples during biopsies have been put to rest. Studies have demonstrated that even with the smaller working channels of TNE scopes, the quality and adequacy of mucosal biopsies for diagnosing EoE are comparable to those obtained during conventional EGD under sedation. • Improved patient tolerance: Distraction methods, especially VR goggles, have enhanced patient cooperation, making it easier to perform repeat TNEs over time. • Cost and efficiency: Lower costs and shorter procedure times are beneficial to families and the healthcare system. Conclusion Transnasal endoscopy represents a transformative advance in the field of pediatric gastroenterology and in rural- urban interface regions where pediatric anesthesia is not readily available. Its ability to safely and effectively evaluate the esophagus without sedation offers clear benefits for children with conditions such as eosinophilic esophagitis. By minimizing procedure times, reducing costs, and decreasing the disruption to family routines, TNE is poised to become the preferred method for monitoring and managing pediatric esophageal disorders. As clinical experience with TNE grows and technology continues to evolve, its role in pediatric care is likely to expand further by broadening the indications for the procedure, improving outcomes and the overall patient experience in a wide variety of upper GI conditions. n Sulaiman Bharwani,MD,pediatric gastroenterologist atArkansas Children’s and professor of pediatrics in the division of gastroenterology at the University of Arkansas for Medical Sciences, is based in North- east Arkansas at the Arkansas Children’s Hospital Jonesboro Clinic. Hamza Hassan Khan, MD, pediatric gastroenterolo- gist atArkansas Children’s and assistant professor of pediatrics at the University of Arkansas for Medical Sciences, practices at Arkansas Children’s Hospital and Arkansas Children’s Northwest. reflux or other upper gastrointestinal issues, like recurrent vomiting or chronic nausea, where a single diagnostic procedure is sufficient, and repeated surveillance may not be needed. Differences Between TNE and Traditional Sedated EGD Traditional EGD usually requires sedation or general anesthesia, particularly in pediatric patients, to minimize discomfort during the procedure. In contrast, TNE is performed while the patient is awake and typically involves: • Topical anesthesia: Instead of intravenous sedation, lidocaine sprays and gargles numb the nose and throat, respectively. • Distraction techniques: To reduce procedural anxiety, patients may wear VR goggles and watch their favorite shows during the exam. • Shorter visit times: TNE can often be completed in a fraction of the time required for sedated procedures. For example, total visit times for TNE have been reported to be approximately 30– 40minutes compared with over two to three hours for a sedated EGD. Advantages for Families and Patients • Convenience: TNE’s convenience is one of its strongest selling points. In rural- urban interface regions like Jonesboro, Arkansas, TNE saves patients the inconvenience and cost of commuting to a larger city like Little Rock. • No sedation concerns: Avoiding sedation reduces the chance of side effects associated with anesthesia and alleviates parental concerns. • Reduced time away from school and work: With significantly shorter check- in, procedure, and recovery times,