TNE Proves Safe, Effective for Esophageal Monitoring

The Transnasal Endoscopy (TNE) Program at Cincinnati Children’s offers patients who need esophageal evaluations an outpatient alternative—one that’s faster, less invasive and does not require general anesthesia. The program started in 2021. Since then, it has expanded, serving more families and training new endoscopists to continue to expand access to this novel technique.

“Our families have been quite happy with the procedure,” says Vince Mukkada, MD, a transnasal endoscopist at the Cincinnati Center for Eosinophilic Disorders. Dr. Mukkada has been performing many of the unsedated TNEs at Cincinnati Children’s since the program’s inception. “Since we started the program, most patients have tolerated TNE with no significant complications. And the majority of our patients who choose TNE continue it rather than go back to standard endoscopy.”

How TNE Compares to Traditional Endoscopy

Patients with eosinophilic diseases need regular monitoring. They may come in for an endoscopy once a year, or as often as every three months. For children, traditional gastrointestinal endoscopies require anesthesia in the operating room. TNE, on the other hand, does not involve anesthesia and happens at an outpatient clinic.

TNE can be much easier on some patients and get them back to their day more quickly, without much interruption. Dr. Mukkada reports that the total time at the office for TNEs is about one hour (for both clinic visit and TNE), compared to traditional endoscopies, which require a patient to be at the hospital for 3-4 hours and have restrictions on their activity for the remainder of the day.

While the procedure is safe, well tolerated and quick, is TNE as effective as traditional EGD in evaluating the esophagus? In 2024, the center looked at the ability of TNE to diagnose key pathologic features in eosinophilic esophagitis (EoE), a food allergy focused on the esophagus.

“We found that the ability for TNE to monitor and diagnosis EoE, even with the smallest of our scopes, allows us to evaluate all details needed in EoE in a way comparable to traditional sedated EGD,” explains Mukkada.

The study compared esophageal biopsies collected using either TNE or conventional endoscopy. The team published their findings in the article: Transnasal Endoscopy Acquired Esophageal Biopsies Adequate for Comprehensive Pathology Evaluation In Patients With Eosinophilic Esophagitis.

New Equipment Broadens Capabilities for TNE

TNEs at the center are even more comparable to traditional endoscopies now because of new equipment. In the past, the center used bronchoscopes. Though effective, they limit TNEs to esophagoscopy (evaluation of the esophagus).

Within the past year, the center has incorporated EvoEndo single-use gastroscopes that can collect tissue not only from the esophagus, but also the stomach and small intestine. That means patients are able to receive unsedated esophagoscopies, as well as fully unsedated esophagogastroduodenoscopies.

“Before, we were limited to evaluation of reflux, dysphagia and swallowing difficulties in EoE,” says Mukkada. “But now, for patients who need it, we can use single-use gastroscopes for gastritis, stomach inflammation, celiac disease and small intestinal biopsies—basically, all the indications that have previously required sedated endoscopy.”

Promoting TNE at Cincinnati Children’s and Beyond

Although use of TNEs began several years ago, it’s still a relatively new, innovative option. Today, many pediatric institutions are starting to develop their TNE programs.

“We’re one of only a few institutions that have been doing this for a while,” says Dr. Mukkada. “It helps that we have a good foundation, being solidly in our fourth year of TNE.”

The program continues to grow. Cincinnati Children’s now offers TNE at three clinics. The number of providers who can do TNE is expanding, too. Along with Mukkada, Rick Taylor, MD, and Eunice Odiase, MD provide TNE at Cincinnati Children’s. And recently, the center faculty successfully trained a fellow who is working as a transnasal endoscopist in Phoenix, Arizona.

“Sharing our expertise in TNE to allow expansion at another institution is a great achievement for the field,” shares Mukkada.

(Published October 2024)

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