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Obes Surg. 2019 Aug 3. doi: 10.1007/s11695-019-04120-y. [Epub ahead of print]

Unsedated Transnasal Endoscopy for Preoperative Examination of Bariatric Patients: a Prospective Study.

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Endoscopy Unit, Alfa Institute of Gastroenterology, Clinics Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Instituto Alfa de Gatroenterologia, Universidade Federal de Minas Gerais - Medicine, Avenida Professor Alfredo Balena, 110, Santa Efigenia, Belo Horizonte, Minas Gerais, 30130-100, Brazil.
Endoscopy Unit, Military Hospital of Minas Gerais, Belo Horizonte, Brazil.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA.
Endoscopy Unit, Alfa Institute of Gastroenterology, Clinics Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil.



Esophagogastroduodenoscopy is a preoperative examination commonly required for candidates to bariatric surgery (BS). Overweight individuals have a greater risk of cardiorespiratory complications during endoscopy under sedation. This study aimed to investigate the feasibility, tolerance, and cardiovascular stress of transnasal endoscopy (TNE) without sedation in obese patients eligible for BS.


This prospective study enrolled obese adult patients with indication for BS that consented to undergo unsedated preoperative TNE. All examinations were carried out in an outpatient center. The outcomes assessed were endoscopic findings, procedural success, patients' tolerance according to a visual analogic scale, cardiovascular stress estimated by double product (i.e., systolic blood pressure × heart rate) and adverse events. Statistical analyses were used to compare each patient's double product among different examination periods.


Ninety-four patients (77.6% female) completed the study, with an average body mass index (BMI) of 53 kg/m2 (range, 35-73.4 kg/m2). There were 63 super-obese individuals (67%), with BMI > 50 kg/m2. In 93 patients (98.9%), unsedated TNE was successfully completed up to the second part of the duodenum. TNE failed in one patient. Tolerance was rated as excellent or good in 95.7%. Minimal cardiovascular stress was noted in obese individuals, whereas the double product remained stable throughout the procedure in super-obese patients. Three patients (3.2%) had self-limited epistaxis.


Unsedated TNE for preoperative endoscopic evaluation of obese patients is feasible, safe, and well tolerated and should be preferentially considered when examining super-obese patients.


Endoscopy without sedation; Obesity; Transnasal endoscopy


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