Table 4

Potential methods in which a transnasal endoscopy service can be expanded beyond standard diagnostic procedures within an endoscopy department

DiagnosticGI bleedAssessment of lower risk bleeds (eg, Glasgow Blatchford score 0 or 1) in the emergency department to triage towards therapeutic endoscopy or facilitate early discharge
Portal hypertensionHepatology/portal hypertension outpatient clinic to diagnose/grade varices
DysphagiaDysphagia outpatient clinic encompassing focused history, and if appropriate direct endoscopic examination
Community screeningProcedures performed in community diagnostic hubs or mobile vehicle
TherapeuticNJ tubePlacement of guidewire and NJ tube to overcome difficult oronasal transfer step
PEG placementNasal unsedated seated PEG placement
Stricture managementAble to more easily traverse difficult strictures to characterise them and assist with guidewire passage and dilatation
Direct visualisation of dilatation of upper oesophageal strictures
Can be passed through gastrostomy to assist with combined antegrade–retrograde dilatation procedure
Dual endoscopyScope passed alongside a gastroscope to assist in retraction of lesions and facilitate endoscopic dissection
  • GI, gastrointestinal; NJ, naso-jejunal tube; PEG, per oral endoscopic gastrosotomy.