Having an upper gastrointestinal (GI) transnasal endoscopy (TNE) (Finchley Memorial Hospital)

What is an upper GI TNE?

TNE is an examination that allows the endoscopist to look inside the upper part of your digestive system - your oesophagus (food pipe), stomach and duodenum (the beginning section of your small intestine) - using an ultra slim (slimmer than a pencil) flexible tube (endoscope) with camera.

Why am I having this procedure?

Your doctor or specialist nurse has referred you to investigate symptoms you have been experiencing, such as abdominal (tummy) pain, indigestion, heart burn, difficulty swallowing, nausea, and vomiting.

This procedure is done by a specially trained healthcare professional called a clinical endoscopist. To make a diagnosis, the endoscopist may need to take small tissue samples (biopsies) which will need to be examined in the laboratory.

A TNE can help diagnose many upper GI conditions, such as inflammation, peptic ulcer, Helicobacter Pylori (HP) infection, coeliac disease (inability to digest gluten) and malignancy (cancer). Additionally, TNE can be helpful in monitoring a long-term health condition or to reassess the healing of previously diagnosed conditions such as peptic ulcer.

Procedure benefits

1. No Sedation Required – The procedure is performed without sedation, allowing for a quicker recovery and return to your usual daily activities, including driving yourself home.
2. The TNE procedure will help to inform a treatment plan based on your endoscopy findings or biopsy results.
3. A TNE can help us review the findings of a previous procedure.

How is a TNE done?

A local anaesthetic spray is applied to the inside of your nose and the endoscope is passed through the nose. Patients experience greater comfort, as it prevents ‘gagging’. While some patients prefer to swallow the endoscope, this route is also vital for those with obstructed nasal passages. The endoscope's small diameter often contributes to a comfortable experience.

Before your TNE procedure

Please do not have anything to eat for at least six hours before your appointment time.

You can drink small sips of water up to two hours before your appointment. Your stomach must be completely empty before your TNE.

This is to make sure the endoscopist has a clear view, and to prevent vomiting. If you fail to follow the above instructions, your TNE will be cancelled and rebooked for another day.

• Make a note of the date of your appointment
• Contact us if you take medicines to prevent blood clots or if you are diabetic
• Contact us if you have had any reactions or allergies to medications or as part of other examinations in the past
• Wear loose-fitting clothes around your neck on the day of the test
• Take all your other medicines as usual, unless you have been told otherwise
• Complete and bring your health questionnaire that we have sent to you.

Your medicines
Please bring a list of all your medications to your TNE appointment.

• If you take blood thinning medication (anti-platelet or anticoagulant medicine) to prevent blood clots or medicine for diabetes, a clinician will call you to discuss this. If you haven't heard from us two days before your appointment, please call our team.
• You should take all your other medicines as usual unless the doctor or specialist nurse has told you otherwise.
• Please inform us if you have glaucoma.

On the day of your TNE procedure

We make every effort to ensure that all patients have their tests soon after arriving in the endoscopy department. At times, emergencies may take priority, and you may need to wait. The endoscopy staff will keep you informed if this happens.

Endoscopy nurse will see you upon your arrival and will show you into the consultation room where preprocedural nursing assessment will take place. You will be asked about your medical history; your vital signs observations will be taken, and you will need to confirm how you have prepared for the procedure.

The endoscopist will explain the procedure and any potential complications to you before you sign your consent form. It is important to think about these in advance so when you sign the form agreeing to the test, you are comfortable with what is involved.

You will be offered a small drink (containing water mixed with Infacol and/or Carbocisteine) to prepare your stomach for the procedure, followed by administration of a numbing nasal spray containing a local anaesthetic (Lidocaine) with decongestant (Phenylephrine) to eliminate any discomfort. Occasionally, the back of your throat may also need to be sprayed with Lidocaine. Please inform the team if you have any allergies to any of these medications.

TNE is performed through one of your nostrils; it is usually a quick examination and often takes no more than 10 minutes to complete. It is well tolerated (no ‘gagging’) and allows you to speak through the procedure, which is something that many patients find comforting and reassuring. Throughout and after the procedure you may feel a little bloated and may experience burping. This is normal and will settle shortly after the test.

During the examination, the endoscopist may take images of your upper gastrointestinal tract and tiny biopsies (tissue samples), which do not hurt. An endoscopy nurse is always present in the room throughout the procedure to help look after you.

After your TNE procedure

You will be allowed to leave the department unaccompanied shortly after the procedure when instructed by the endoscopist or the nurse, who will provide written discharge information to take home with you.

You will have to wait up to one hour before having anything to eat or drink, to allow the local anaesthetic to fully wear off.

After the local anaesthetic wears off, you may experience a slight sore throat and/or some soreness at the back of the nose. This usually clears up within a day or two spontaneously. If you experience persistent pain in your face, please contact your GP.

If you have a severe pain, black tarry stools or persistent bleeding, you should contact your nearest emergency department (A&E) for further advice and inform us on 020 3758 2014

Risks and side-effects

Minor complications
Fewer than one per cent of patients may experience a nosebleed, which usually settles spontaneously. In rare cases patients may experience facial discomfort around their nose and forehead, if this persists a few days after the procedure please contact your GP who can assess you further.

Major complications
There is a small risk (1 in 5,000) of haemorrhage (GI bleeding) and 1 in 10,000 risk of perforation (tear) in the upper GI tract, which may require surgery. Other rare complications include a chest infection, a more persistent nosebleed that would require further intervention and treatment.

TNE alternatives

If TNE is unsuccessful, for example it is not possible to pass the endoscope through your nose, the endoscopist may offer you to have this procedure through your mouth (transoral).  If you choose not to have it or cannot tolerate oral route, alternative options will be discussed with you.

Further questions

This leaflet provides information about the procedure and what you can expect, we want patients to feel at ease with the procedure. If after reading this leaflet you have any further questions or have any additional support requirements, please contact Endoscopy/TNE administrative team at Finchley Memorial Hospital Community Diagnostic Centre on 020 3758 2014.