Transnasal Endoscopy in Unsedated Children With Eosinophilic Esophagitis Using Virtual Reality Video Goggles.
BACKGROUND & AIMS
Evaluation and treatment of children with eosinophilic esophagitis (EoE) requires serial endoscopic, visual, and histologic assessment by sedated esophagogastroduodenoscopy (EGD). Unsedated transnasal endoscopy (TNE) was reported to be successful in a pilot study of children. We evaluated video goggle and virtual reality-based unsedated TNE in children with EoE, collecting data on rates of completion, adverse events, and adequacy of visual and histologic findings.


METHODS
We performed a retrospective study of 190 children and young adults (age, 3-22 y) who underwent video goggle or virtual reality-based unsedated TNE from January 2015 through February 2018. We analyzed data on patient demographics, procedure completion, endoscope type, adverse events, visual and histologic findings, estimated costs, and duration in the facility. Esophageal biopsies from the first 173 subjects who underwent TNE were compared with those from previous EGD evaluations.


RESULTS
During 300 attempts, 294 TNEs were performed (98% rate of success). Fifty-four patients (age, 6-18 y) underwent multiple TNEs for dietary or medical management of EoE. There were no significant adverse events. Visual and histologic findings were adequate for assessment of EoE. TNE reduced costs by 53.4% compared with EGD (TNE $4393.00 vs EGD $9444.33). TNE was used increasingly from 2015 through 2017, comprising 31.8% of endoscopies performed for EoE. The total time spent in the clinic (front desk check-in to check-out) in 2018 was 71 minutes.


CONCLUSIONS
In a retrospective study of 190 children and young adults (age, 3-22 y) who underwent video goggle or virtual reality-based unsedated TNE, TNE was safe and effective and reduced costs of EoE monitoring. Advantages of TNE include reduced risk and cost associated with anesthesia as well as decreased in-office time, which is of particular relevance for patients with EoE, who require serial EGDs.
['Nguyen|Nathalie|N|', 'Lavery|William J|WJ|', 'Capocelli|Kelley E|KE|', 'Smith|Clinton|C|', 'DeBoer|Emily M|EM|', 'Deterding|Robin|R|', 'Prager|Jeremy D|JD|', 'Leinwand|Kristina|K|', 'Kobak|Greg E|GE|', 'Kramer|Robert E|RE|', 'Menard-Katcher|Calies|C|', 'Furuta|Glenn T|GT|', 'Atkins|Dan|D|', 'Fleischer|David|D|', 'Greenhawt|Matthew|M|', 'Friedlander|Joel A|JA|']
D000293:Adolescent D001706:Biopsy D002648:Child D002675:Child, Preschool D019468:Disease Management D016145:Endoscopy, Digestive System D057765:Eosinophilic Esophagitis D004945:Esophagoscopy D004947:Esophagus D005260:Female D006801:Humans D008297:Male D012189:Retrospective Studies D000080310:Smart Glasses D013997:Time Factors D000076142:Virtual Reality D055815:Young Adult
Endoscopy Adverse Events Anesthesia Eosinophilic Oesophagitis Transnasal Esophagogastroduodenoscopy Transnasal Esophagoscopy