Conventional esophagogastroduodenoscopy (cEGD) is increasingly performed under sedation, adding costs and logistical complexity, while delaying patients’ return to normal daily activities. Transnasal esophagogastroduodenoscopy (tnEGD) emerged as a less invasive, better-tolerated alternative to cEGD. Several UK centres have reported high patient acceptance and superior comfort compared to cEGD, with fewer instances of gag reflex, reduced cardiovascular stress and no need for sedation enabling immediate return to usual daily activities. Recent data show that new generation tnEGD offers comparable diagnostic accuracy for oesophageal and gastric pathology, including early gastric cancer and premalignant conditions, while improving throughput, reducing use of resources, and facilitating outpatient-based endoscopic services. Despite its benefits, there is no widespread use in continental Europe.Conventional esophagogastroduodenoscopy (cEGD) is increasingly performed under sedation, adding costs and logistical complexity, while delaying patients’ return to normal daily activities. Transnasal esophagogastroduodenoscopy (tnEGD) emerged as a less invasive, better-tolerated alternative to cEGD. Several UK centres have reported high patient acceptance and superior comfort compared to cEGD, with fewer instances of gag reflex, reduced cardiovascular stress and no need for sedation enabling immediate return to usual daily activities. Recent data show that new generation tnEGD offers comparable diagnostic accuracy for oesophageal and gastric pathology, including early gastric cancer and premalignant conditions, while improving throughput, reducing use of resources, and facilitating outpatient-based endoscopic services. Despite its benefits, there is no widespread use in continental Europe. We aim to test the feasibility and efficacy of tnEGD in the first transnasal unit in Iberia.

This  study included all tnEGD performed between April and November 2025. Before starting, the team of doctors, nurses and assistants, went through a dedicated learning program. Prospective data collection was performed, including patient demographics, procedural success, tolerance, adverse events, and patient-reported satisfaction through standardized Likert-scale questionnaires. All patients had a telephone interview one week after the procedure.

During this period, 291 procedures (in 290 patients) were performed for diagnostic purposes. Most frequent indications were pre-surgical assessment (28%), dyspepsia/GERD (16%), post-surgical evaluation (10%) and premalignant gastric conditions surveillance (10%). Complete tnEGD was possible in 265 procedures (91%). Incomplete cases were related to nasal cavity anatomical limitations in 22 patients (nasal conchae hypertrophy/congestion), while only 2 cases were due to patient intolerance. There were 7 immediate adverse events (AE): 5 nasal discomfort/pain and 2 mild epistaxis – all self-limited. Concerning the following days after the procedure, 13 patients reported late AE: 6 mild epistaxis, 5 rhinosinusitis, 1 migraine and 1 throat irritation. Overall, 226 patients (77.9%) reported being satisfied with the examination and 228 (78.6%) patients would repeat the examination. Among 135 individuals who had previously undergone cEGD, 121 (89.6%) reported the tnEGD to be more comfortable.  Regarding the costs related to sedation (previous analysis, anesthesiologist and nurse fee), a saving of approximately €63.60 per procedure is estimated.

This early experience in a large cohort confirms that tnEGD is a well-accepted, highly tolerable, and safe alternative to cEGD, maintaining procedural efficacy while enhancing patient satisfaction. These results were consistent since the beginning of operations and support wider implementation of tnEGD across Europe.