Transnasal endoscopy (TNE) has emerged as a comfortable, sedation-sparing and resource-efficient alternative to the conventional oesophagogastroduodenoscopy (OGD). We aimed to evaluate feasibility, completion rates, safety, tolerance and indications for diagnostic TNE, predominantly in the outpatient setting across three sites of Barking Havering & Redbridge University Hospitals NHS Trust (BHRUT).

A retrospective observational study included all consecutive TNE procedures performed between 01/05/2025 and 31/10/2025 at BHRUT. Procedures were performed using two ultrathin endoscope models: the Olympus GIF-H190N and the Pentax EG17-J10. Data collected included demographics, indication, use of nasal anaesthesia, sedation use, comfort score (0–4), completion to second part of the duodenum (D2), conversion to oral gastroscopy, and adverse events. Descriptive statistics were used to summarise outcomes.The majority of procedures were undertaken in the outpatient and ambulatory setting, aligned with the new Trust’s transition of diagnostic OGD to TNE within Community Diagnostic Centres (CDC) and one-stop Faster Diagnostic Service (FDS) pathways. 

A total of 138 procedures were included. The mean age was 60,8 years (range 17-89) and 70 patients (51%) were female. Most procedures were performed in the outpatient and ambulatory setting (n= 80, 58%). Nasal anaesthesia was almost universally used (n=135, 98%), while sedation was infrequently required (n=28, 20%).Patient tolerance was high, as 126 patients (92%) reported a comfort score of 0 (no discomfort) or 1 (minimal discomfort). No patient reported the highest discomfort score of 4.Completion to D2 was achieved in 134 cases (97%), comparable to conventional OGD. Conversion to oral gastroscopy occurred in 8 cases (6%), mainly due to narrow nasal cavity (n=4, 3%) or patient intolerance (n=3, 2%). No adverse events were recorded.

TNE was performed for a wide range of clinical indications, mirroring those of standard OGD. The most common was dysphagia, accounting for 42.8% of all referrals. Other frequent indications included dyspepsia (25.4%), unintentional weight loss (18.8%), abdominal pain (13.8%), heartburn (11.6%), nausea (9.4%), and anaemia (7.2%). Less frequent indications included vomiting, bloating, oesophagitis and Barrett’s surveillance. This demonstrates the broad applicability of TNE across both diagnostic and surveillance pathways.

In this real-world UK cohort, transnasal endoscopy demonstrated excellent safety, high patient tolerance, and strong technical performance, comparable to conventional OGD, while offering clear operational advantages. The high completion rate, low conversion rate, minimal sedation use, excellent comfort scores and absence of adverse events highlight its suitability as a first-line diagnostic modality within ambulatory and Faster Diagnostic Service pathways. Particularly in our case, the introduction of ambulatory TNE within the CDC has freed capacity in core endoscopy rooms, enabling expansion of OGD services and supporting additional Trust-wide initiatives. These findings support broader adoption of TNE to improve patient experience, streamline diagnostic pathways and enhance system-wide efficiency. Further prospective work should assess cost-effectiveness and long-term patient-reported outcomes.