TRANSNASAL ESOPHAGOSCOPY (TNE)
“Anyone with acid reflux or who has chronic hoarseness, heartburn, indigestion, sore throat, difficulty swallowing, or chronic cough should have a screening transnasal esophagoscopy performed to rule out Barrett’s esophagus or esophageal cancer.” Dr. Jamie A. Koufman
Transnasal esophagoscopy (TNE) is a technology that allows for examination of the esophagus, the swallowing tube between the throat and stomach, without the patient being put to sleep. Most commonly, this is done to check for cancer and other esophageal disorders. Indeed, the technology has changed. Doctors can now look inside while patients are awake, comfortable, and without pain, using TNE. The idea that you can only be checked for cancer in a special facility and under anesthesia is archaic. Anyone who has difficulty swallowing, painful swallowing, or who had acid reflux, should have a TNE examination. TNE is currently the best method for “screening” the esophagus for trouble. Depending on the findings of the TNE, other diagnostics may be needed.
Transnasal esophagoscopy (TNE) literally means through-the-nose examination of the esophagus (the swallowing tube that connects the throat and the stomach). This is done by numbing one side of the nose with xylocaine and then sliding a small, soft flexible tube through the nose, bypassing the throat area, and going straight into the opening of the esophagus behind the larynx (voice box). TNE can be performed with patients awake and comfortable without putting them out (asleep or sedated) in any way. The TNE examination is every bit as comprehensive and thorough as older more expensive and invasive methods that require sedation in a special endoscopy facility.
The beginnings of TNE are interesting. In 1999, Nicholas Tsaclas, a endoscopic equipment salesperson — at that time employed by Pentax, and more recently employed by Vision Sciences – brought the new long endoscope to two ENT physicians, Dr. Jonathan Aviv and Dr. Jamie Koufman. Both doctors immediately recognized the spectacular potential afforded by the new technology. It meant that patients could be examined awake, in a regular medical office setting. The first TNE publication was by Dr. Jonathan Aviv in 2001.
In the years since its introduction, TNE has not proliferated as rapidly as it should have. Unfortunately, the reasons for this have more to do with turf wars between medical specialists than the needs of patients. At this point, there may be as many as 100 million Americans who need esophageal screening, and at present about 10 million esophageal examinations are performed each year, mostly by gastroenterologists in expensive facilities with the patients under sedation. The estimated facility costs for these procedures are $10 billion per year.
Epidemic Acid Reflux, Barrett’s Esophagus, and Esophageal Cancer
Acid reflux is a high-prevalence disease, which comes in two forms, laryngopharyngeal reflux (LPR) and gastroesophageal reflux disease (GERD). Typically, LPR patients have reflux during the day without having heartburn or esophagitis; whereas GERD patients tend to have heartburn and to reflux more at night than during the day.
Acid reflux disease (GERD and LPR) has increased dramatically in the past 50 years; it has increased on average 4% per year. In 2010, we did a study to estimate the prevalence of reflux (GERD and LPR) in America. We found that 40% had reflux disease with 22% having GERD and another 18% (118/656) having LPR. One of the most striking findings was that 37% of the 21-30 year-old age group had reflux. In the past, reflux was primarily a disease of overweight, middle-aged people.
During the same 50 year period, esophageal cancer increased 800%; and in addition, it is now seven-times more deadly. Equally important, Barrett’s esophagus, the precursor to esophageal cancer) is now being seen in 7%-10% of people with LPR and GERD, that is patients with hoarseness, chronic cough, sore throat, and heartburn. Routine esophageal screening for both LPR and GERD patients is recommended.