{
  "abstract": "Introduction A transnasal endoscopy (TNE) service was introduced in 2021 at a small district general hospital. Previously, if a gastroscopy was not tolerated under pharyngeal anaesthesia and/or conscious sedation, the patient would proceed to a gastroscopy under general anaesthetic (GA gastroscopy) in the operating theatres, which were under significant service pressure. After implementation of the TNE service, patients were evaluated for suitability for proceeding to TNE as an alternative to GA gastroscopy. This service evaluation was carried out to determine whether the Introduction of a TNE service impacted the number of elective GA gastroscopies performed.Methods A retrospective service evaluation was conducted using data sourced from hospital information services before and after TNE implementation. Data was collected on the number of GA gastroscopies performed pre-implementation of TNE (01/09/2018 to 31/10/2021; 38 months), and post-implementation of TNE (01/11/2021 to 31/12/2024; 38 months). GA gastroscopies were included if they were elective procedures in patients over 16 years old. GA gastroscopies were excluded if a therapeutic procedure or an additional investigation under GA was planned. Elective TNE procedures performed in patients over 16 years old were included (01/11/2021 to 31/12/2024; 38 months). Indications and success rates for each were also collected. Average monthly procedure rates of GA gastroscopies were compared using a two-sample Poisson rate test.Results The rate of GA gastroscopy decreased from 0.921 procedures per month (n=35) pre-implementation to 0.447 procedures per month (n=17) post-implementation. This demonstrates a statistically significant reduction of 51.5% (p=0.013).A total of 84 TNE procedures were performed. 13 could not be completed via nasal route. Of these, 10 were successfully completed via oral route using the TNE scope, and the remaining 3 could not be completed. This demonstrates a non-diagnostic rate of 3.6%. All GA gastroscopies were completed successfully.The proportion of elective GA gastroscopies performed after a patient had not tolerated gastroscopy decreased from 62.9% pre-implementation to 35.3% post-implementation of the TNE service.Conclusions A significant reduction of 51.5% in elective gastroscopies performed under general anaesthetic was observed after the Introduction of a transnasal endoscopy service. This service evaluation demonstrates an important alternative for endoscopists to consider when a patient has been unable to tolerate gastroscopy, improving timeliness of diagnosis and management while reducing overall costs and pressures on operating theatres and anaesthetic teams.",
  "authors": [
    {
      "affiliations": [
        "Airedale NHS Foundation Trust, Keighley, United Kingdom"
      ],
      "name": "Thomas Lloyd"
    },
    {
      "affiliations": [
        "Airedale NHS Foundation Trust, Keighley, United Kingdom"
      ],
      "name": "Chantelle Shaw"
    },
    {
      "affiliations": [
        "Airedale NHS Foundation Trust, Keighley, United Kingdom"
      ],
      "name": "Susanna West"
    },
    {
      "affiliations": [
        "Airedale NHS Foundation Trust, Keighley, United Kingdom"
      ],
      "name": "Richard Shenderey"
    }
  ],
  "title": "P271 Transnasal endoscopy as an alternative to elective gastroscopy under general anaesthetic: a service evaluation",
  "uid": "eea6e1c7-fde5-5ffe-932c-eff76726deac"
}