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2015 ; 3
(6
): E538-46
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Anterior meatuscopy is more reliable than a sniff test for predicting nasal
patency before transnasal endoscopy
#MMPMID26716108
Hu CT
Endosc Int Open
2015[Dec]; 3
(6
): E538-46
PMID26716108
show ga
BACKGROUND AND STUDY AIMS: Unsedated transnasal esophago-gastro-duodenoscopy
(UT-EGD) has been performed for at least two decades but many techniques related
to the procedure have yet to be standardized. We aimed to develope a simple
endoscopic method, anterior meatuscopy, to replace the sniff test for selecting
the most patent nasal meatus before UT-EGD. We hypothesized that access to the
common nasal meatus (CNM), if confirmed by anterior meatuscopy, was a safer route
than the inferior (INM) and middle nasal meatuses (MNM) because it would result
in reduced epistaxis, nasal pain, and nasal discharge. PATIENTS AND METHODS: We
used anterior meatuscopy and an endoscopic meatus scoring scale (EMSS) to
identify the optimal meatus for insertion. We evaluated the EMSS frequency
distributions for the INM, CNM, and MNM and the reliability of a sniff test in
1,000 consecutive patients. The adverse effects of passing through the CNM versus
the INM and MNM, respectively, were compared. RESULTS: In the INM and MNM, the
EMSS frequencies were grade I?>?II?>?III?>?0 whereas those in the CNM were grade
II?>?I?>?0?>?III. A sniff test was not reliable, given its low sensitivity
(63.3?%), specificity (67.3?%), positive predictive value (69.1?%), negative
predictive value (61.4?%), and accuracy (65.2?%). Although only 9.2?% of our
patients had grade III anterior-to-posterior CNMs, passage through this spacious
CNM rather than through the MNM or the INM could significantly reduce epistaxis,
nasal pain, and nasal discharge. CONCLUSIONS: Anterior meatuscopy is more
reliable than a sniff test before UT-EGD. Transnasal endoscopic passage through
the endoscopically patent CNM, if detected by anterior meatuscopy, may prevent
epistaxis and nasal pain and minimize nasal discharge.