What is transnasal esophagoscopy (TNE)?

Transnasal esophagogastroduodenoscopy, or TNE, is a non-sedated procedure where a doctor who specializes in the gastrointestinal system uses a special tool called an endoscope. The endoscope is a thin, flexible tube that is gently passed through the nose and down into the throat to look at the upper part of the digestive system. This includes the esophagus (commonly called the “food tube”), the stomach, and sometimes the first part of the small intestine (duodenum).  

TNE is becoming more commonly used as an alternative to traditional upper endoscopy, as it does not require sedation or general anesthesia, making it a safer choice for some patients. 

Who is TNE recommended for?

Transnasal esophagoscopy – also known as unsedated transnasal endoscopy – allows patients aged 7 and older to have their upper GI tract evaluated without the need for anesthesia. This is especially valuable for patients with eosinophilic esophagitis (EoE), a chronic allergic condition where the esophagus becomes inflamed secondary to food and environmental allergens. Children with EoE often require repeated procedures to monitor their disease.

When is TNE performed?

Transnasal esophagoscopy is often used to investigate symptoms that may be a sign of problems in the upper digestive system, such as nausea, reflux, abdominal pain and difficulty swallowing (dysphagia).  

During the procedure, the doctor may take small tissue samples (biopsies) to be examined under a microscope for signs of disease.  

TNE is also often used for patients who need regular check-ups of their upper digestive tract, such as children with eosinophilic esophagitis (EoE).

How should my child prepare for transnasal esophagoscopy (TNE)? 

Before the procedure, your child will be assessed by a gastroenterologist to ensure TNE is the best testing option. Once approved, the procedure will be scheduled in Kohl’s GI Nutrition and Diagnostic Center at Children’s Hospital of Philadelphia (CHOP) or one of CHOP’s Specialty Care Centers or select affiliates. 

Your child will need to avoid eating solid food for 2 hours before the procedure. (We will provide more detailed instructions before the procedure.) 

When you arrive at our Outpatient Suite, a staff member will help with check-in. Afterward, a nurse will bring your child and family member to the procedure room, where they will assess your child’s vital signs, take their temperature, check their heart rate and monitor their blood pressure. 

The doctor will explain the procedure to you and your child and ask for permission (informed consent) to proceed. If you agree, the procedure will begin. Your child can choose to watch their procedure using virtual reality goggles or watch a video or listen to music for distraction. Don’t worry if you are unfamiliar with these devices – our staff will guide you! 

What happens during TNE?

Once everyone is ready for the transnasal esophagoscopy to begin, we will numb your child’s nasal cavity and throat. This will allow us to more comfortably pass the endoscope through the upper GI system.  

Your child will be asked to “snort” a jelly-like substance called lidocaine or apply a nasal spray to numb the area. (Sometimes, it helps to practice before the day-of-procedure with an over-the-counter nasal spray so your child gets used to the sensation of the spray.) 

The endoscope is then inserted into your child’s nostril and advanced to the back of the throat.  

Your child will be asked to swallow or take a sip of water to open the entrance to the esophagus so the gastroenterologist can pass the scope through. Once inside the esophagus, the doctor will advance the endoscope to the stomach and obtain the necessary tissue samples (called a biopsy). The scope is then withdrawn and samples sent for testing. 

The numbing agent usually lasts 15-20 minutes, which gives clinicians enough time to complete the short procedure. 

Benefits of transnasal esophagoscopy (TNE)? 

TNE is sedation-free, meaning your child won’t need to be put under general anesthesia. This can lead to a shorter recovery time and a quicker return to normal activities. Because this procedure does not require sedation, there are fewer risks associated with it. Additionally, TNE is often less expensive than traditional endoscopy, which may help lower out-of-pocket costs for your family.