As published in Calibre Magazine by Public Bank 2018 & Ramsey Sime Darby Newsletter, Feb 2018 issue
The transnasal endoscopy (TNE) proves to be one of the best breakthroughs in the medical industry due to the utmost comfort it provides to the patients. Dr Prabhjot Singh Sidhu, Consultant Gastroenterologist, Hepatologist and Physician of Ara Damansara explains further about the technique and the instances when the TNE is performed.
Upper endoscopy is generally regarded as an uncomfortable practice that involves a relatively large tube going into the body via the mouth. The procedure requires the patient to lie down either on one side or the back and more often than not sedatives are meted out into the forearm. The doctor will also spray an anaesthetic at the back of the throat to ease the insertion of the scope and the patient will be asked to wear a plastic mouth guard to keep their mouth open. Once the procedure is over, patients are monitored for a few hours as the sedatives wear off.
“With the transnasal endoscopy (TNE) we effectively remove all these extensive preparations as well as the post-procedural routine that is required when performing the conventional endoscopy. As the technique is carried out via the nostrils instead of the mouth, it gives a lot more freedom as well as comfort for patients undergoing the TNE, as they are not bound to a table on their side or forced to wear a mouthguard. Sometimes we even carry it out in an outpatient setting,” explains Dr Prabhjot.
The way the TNE works is especially simple. As a diagnostic and therapeutic tool, patients are either recommended to undergo the examination or voluntarily opt for it as part of their health screening. Nevertheless, unlike the lengthy preparation process necessary for an upper endoscopy, patients only need to sit upright during a TNE examination and anaesthetic at will may be administered at the back of their throat and the nose.
“As the nose is very fragile, we will spray a topical anaesthetic into the nose to numb it and to allow the nostrils to expand further for comfort. The endoscope is then inserted via a nostril of the patient’s preference and voila, the gastroenterologist will have the visuals needed for examination,” Dr Prabhjot says. While seated and feeling comfortable, the patient is also able to look at the same screen detailing the scope’s passage as the doctor does. This allows them to be more aware of their inside and ask the doctor important questions for a better understanding of their body.
“Since the patient is not wearing a mouth guard or having a tube go into their mouth, they are able to speak and ask me questions, which as their consultant I am more than ready to answer. In my opinion, patient education is paramount. Through TNE, they are able to learn more about their body in real-time. Besides, the procedure is so relaxing for patients that I have even had some of them sing for me,” reveals Dr Prabhjot.
Although very comfortable, the TNE is not performed under certain circumstances. Patients with acute sinusitis or any form of nose injury are advised against the procedure. Furthermore, the transnasal endoscopy is also avoided when there is internal bleeding as it does not have enough treatment modalities within due to its small size to treat such conditions.
“However, the advantages of the TNE far outweigh its shortcomings. Not only does its small size allow it gets through oesophageal strictures or function as a secondary scope, the fact that it is inserted via the nose allows it to be used to assist in the placement of a feeding tube for patients who cannot open their mouth for various reasons, including stroke,” elucidates Dr Prabhjot.
The entrance via the nostrils also opens up other possibilities for the TNE, such as potential detection of irregularities in the nasal cavity, as well as the rest of the gastrointestinal tract. Its comfortable nature, on the other hand, allows doctors to spend longer time examining the necessary as the patient is not moving around due to anxiety or gag reflex.
“When I discover any irregularities in the nose or throat, I will immediately advise the patient to see an ENT (Ear, Nose and Throat) doctor. With TNE, patients could even have their family members in the room with them for added support. But, of course, ultimately it is the patient’s decision as to which scope they prefer for a gastroscopy,” he says.
According to Dr Prabhjot, when patients understand the reasons behind their symptoms through explanations and visuals—as is possible with TNE—not only do they get better at their own disease management, they also get better faster. Nonetheless, as a locally- based hepatologist, he is also concerned about the livers of Malaysians.
“Most Malaysians nowadays have developed fatty liver due to but not exclusively to unhealthy eating behaviours. It is important to eat in moderation and drink a lot of water to attain a healthy body. We must also always be alert to any changes to our body from the norm. Mostly it is our body’s way of letting us know that we need to get it checked and definitely not ignore the warning signs,” emphasises Dr Prabhjot.
