Children treated for eosinophilic esophagitis (EoE) and other esophageal disorders at Riley Children’s Health are benefiting from a leading-edge procedure—unsedated transnasal esophagoscopy (TNE)—that provides safe and effective disease surveillance without many of the limitations of esophagogastroduodenoscopy (EGD).
EGD, used to diagnose and monitor gastrointestinal disorders, requires general anesthesia or sedation. Requiring an outpatient stay of at least four hours, recovery time and additional medical support, EGD is also a time-intensive and costly procedure for patients and families.
“For many EoE patients, zeroing in on the right treatment or combination of therapies can take time, requiring repeat endoscopies to evaluate the effectiveness of treatments such as acid-blocking medications, topical steroids and dietary changes,” said Ryan T. Pitman, MD, MSC, a pediatric gastroenterologist at Riley Children’s. “We’re finding that transnasal esophagoscopy is a faster way to find the targeted treatments that work best for our patients.”
Riley Children’s is one of the only children’s hospitals in the Midwest offering TNE, a nonsurgical procedure that involves passing an endoscope through the nose to examine the esophagus. It’s an ideal method for the monitoring needed in the long-term management of EoE because it requires no sedation or anesthesia and can be completed in an outpatient office in less than an hour. With no recovery time, the patient can return to school and other daily activities immediately following the procedure.
“For patients with symptoms and in active treatment for EoE, the standard of care is to perform an endoscopy every several weeks,” Dr. Pitman said. “With transnasal esophagoscopy, we’re able to assess modifications in therapy without having children undergo anesthesia and asking families to spend a full day at the outpatient center for a procedure that takes just a few minutes. It’s also great for older children and teenagers who have been stable and then experience a flare-up or new symptoms.”
TNE has been used to monitor EoE in pediatric patients since 2014. At Riley Children’s, Dr. Pitman and his colleague, pediatric gastroenterologist Paroma Bose, MD, have been performing four to five TNE procedures per month for nearly a year. While they have used TNE to monitor patients as young as 2 years old, given the nature of the procedure, which requires that the child remain relatively still and the application of a topical nasal anesthetic, it’s better suited for patients who are nine years and older.
“For most children with EoE, they’re looking at multiple scopes to evaluate their disease,” said Dr. Bose. “Especially for very young children, we’re concerned about the burden of repeated exposure to anesthesia over time, so in that regard alone, having TNE as an alternative to traditional sedated endoscopy is a benefit to patients.”
The availability of TNE for pediatric patients is still relatively limited nationwide. Offering it requires investment in equipment suitable for the pediatric population and specialized training for physicians performing the procedure. Currently, there isn’t a standardized training protocol for pediatric TNE. To learn the procedure, Drs. Pitman and Bose trained with adult otolaryngologists at Indiana University Health, of which Riley Children’s is a part, and consulted with colleagues performing pediatric TNE in Colorado, where the procedure was first widely used in children.
“We’ve had great success with this procedure at Riley Children’s, and our kids have done well,” said Dr. Pitman. “It’s quick, effective, and we’re able to get the critical information we need to make the disease management changes necessary to alleviate symptoms and achieve better results for our patients.”
About Pediatric Gastroenterology at Riley Children’s Health
The Riley gastroenterology program is renowned for their care, thanks to our long history of studying and treating conditions of the digestive tract, liver and pancreas. Dr. Joseph F. Fitzgerald, MD, who pioneered the field of pediatric gastroenterology, founded the Division of Pediatric Gastroenterology, Hepatology & Nutrition in 1969 within the Indiana University School of Medicine Department of Pediatrics.