Dr. Nicholas CaJacob performs a transnasal endoscopy on a patient using a new endoscope manufactured by EvoEndo.
Children’s of Alabama is among the first 10 pediatric medical centers in the nation to use a new endoscope that can make transnasal endoscopy (TNE) faster and easier for some patients with eosinophilic esophagitis (EoE). The device, manufactured by EvoEndo, was approved by the U.S. Food and Drug Administration last year. Children’s began using it in June 2023.
EoE is a chronic immune-mediated inflammatory disease of the esophagus resulting in symptoms and signs of esophageal dysfunction. Physicians use endoscopy every two to three months to biopsy tissue to evaluate treatment success. The new endoscope, which is inserted through the nose into the esophagus, requires no general anesthesia, just an anesthetic spray to numb the nasal passages. Patients remain awake during the procedure and need to fast only for two hours prior. Virtual reality goggles keep patient’s focus off the procedure, while a family member can be in the room observing and getting updates in real time. Children’s pediatric gastroenterologist Diana Montoya Melo, M.D., says it’s a potential game changer for patients and their families.
Montoya Melo and Nicholas CaJacob, M.D., also a pediatric gastroenterologist at Children’s, each perform about 10 EoE endoscopic procedures a week.Previously, the standard endoscopic procedure involved inserting the endoscope through the mouth into the esophagus. That method requires general anesthesia and intubation, fasting for at least six hours, a very early arrival at the hospital, IV insertion and about an hour in the recovery room after the 10-minute procedure—all of which puts a tremendous burden on the family and increases costs and the risk of potentially serious side effects.
With the new device, transnasal endoscopies takes about 15 minutes, and Montoya Melo expects the endoscopy team to be able to complete them even faster as they gain more experience. Patients also are able to leave right after the procedure. “We don’t have to monitor anything,” she said. “We’re getting the same results but in a safer, more convenient way for families and patients.”
An added bonus, Montoya Melo says, is that the endoscope is disposable. “Families like to know that it hasn’t been used on anybody before.” This also expedites the procedure because doctors don’t have to process or reprocess the equipment. “We just take it out of the box and use it,” she said. The device is approved for children 5 and older, although most centers limit its use to those 10 and older, she says.
TNE isn’t for everyone. “There are some children who are more anxious, or they will not tolerate the endoscope going through the nose,” Montoya Melo said. “This is mostly for patients and families who are interested in a different approach.” One way to know if a child is a good candidate? “We ask how they tolerated their COVID test,” she said. “And we tell them it won’t feel any worse than that.”