We are excited to offer our patients the latest minimally invasive diagnostic examination for evaluating the health of your esophagus and stomach. The procedure is called Transnasal Esophagoscopy or TNE. It involves the use of a very small, high resolution, flexible endoscope (5mm in diameter) to inspect the inside of the entire esophagus and stomach, and it is done right here in our office.
Unlike conventional endoscopy, there is no need for sedation or general anesthesia. We use local anesthesia to minimize any sensitivity or discomfort in the nose and throat. So, you can have the exam, which takes less than half an hour, and go right back to work or any other activity. There’s no need to have someone accompany you, since you’ll be able to drive yourself, and you’ll also be able to eat right away. Before your TNE exam, we ask that you not eat or drink anything for four hours prior to the procedure. Afterward there are really no restrictions. Patient Instructions of TNE
Screening Examination of the Esophagus (WATCH VIDEO)
TNE is an excellent screening test for Barrett’s Esophagus, a pre-cancerous condition that occurs in about 10% of patients with poorly controlled gastric reflux, as well as hiatal hernia, strictures and other conditions affecting the esophagus. If you have symptoms that require medications more than once a week, and you haven’t had an exam in the past two years, we’d recommend you consider having the TNE screening examination. This can be performed during your initial appointment, or we can schedule it at a separate time if you prefer. Just check with our office staff when you schedule your appointment, and they will be happy to set aside the extra time.
Following your TNE examination, Dr. Sewell will discuss his findings with you and make appropriate recommendations. If you have additional questions regarding the diagnosis or treatment of any esophageal conditions you can find more information on our web site at www.myheartburnisgone.com, To make an appointment call 817–748–0200 or contact us ONLINE.
The cost of TNE is significantly less than conventional endoscopy because there is no hospital or facility fee. Considering the peace of mind that comes with knowing the health of your esophagus, this screening examination offers a real value to those with chronic reflux, or anyone who is at risk of having a more serious condition like Barrett’s Esophagus go undiagnosed. The total cost is $500.00, including the consultation, and our staff will be happy to assist you in getting reimbursed by your insurance carrier.
Before initiating any treatment of GERD, the inside of the esophagus and stomach should be examined directly with a procedure called an endoscopy, or EGD. This can be performed in the office under local anesthesia with a Transnasal technique and a very small scope, or in the hospital or endoscopy center using a larger conventional scope, which requires intravenous sedation. These procedures allow for the anatomy and relative health of the upper GI tract to be evaluated from the inside. With conventional endoscopy biopsies can be performed.
Patients with chronic GERD can sometimes have ulcerations and even bleeding in the esophagus. Scarring may result from chronic acid reflux that may lead to a narrowing or stricture of the esophagus. In about 10% of patients with chronic GERD, the lining of the lower esophagus actually undergoes a change that makes it look more like the lining of the stomach. This condition is called Barrett's Esophagus, and is associated with an increased risk of esophageal cancer.
When Acid Reflux is suspected but not confirmed, it may be necessary to actually measure the amount of acid in the esophagus over a 24-48 hour period to confirm the diagnosis of GERD. Traditionally, this was accomplished by placing a tube down through the nose into the esophagus, which was connected to a monitoring device. Today, this rather uncomfortable procedure has been replaced by a less cumbersome process where a tiny capsule, called a Bravo Probe, is attached during an endoscopy directly to the lining of the esophagus. The probe measures the amount of acid in the esophagus and transmits the information to a small electronic device about the size of a cell phone, which is worn on the patient's belt. After 2 days the data from the monitor is downloaded to a computer for analysis. For the test to be accurate the patient must remain off all acid supressing medication, like PPIs and H2-Blocker for 7 days prior to beginning the study. It is okay to use antacids like Rolaids, Tums, Maalox or Mylata to control acid symptoms during the pre-testing time, but even these medication need to be avoided during the 48 hours of the actual test.
The Bravo Probe is completely disposible and releases from the lining of the esophagus after about 7 to 10 days. It then passes through the intestinal tract and out of the body along with a bowel movement. While the probe is in place, some patients experience slight discomfort with swallowing, but this is temporary and generally does not require an alteration in diet.
Additional testing is often required, not only to ensure the diagnosis is in fact gastroesophageal reflux, but also to assess the functional capability of the esophagus. One such test is called Esophageal Motility
or Esophageal Manometry
. To accurately measure the strength of esophageal contractions, a small catheter is placed through the nose down into the stomach. There are multiple pressure monitors along the length of the catheter which provide a clear picture of exactly what is happening during the process of swallowing. The test typically take about 30 minutes to perform, and the information obtained can be very helpful in determining the safest and most effective treatment. We use the latest "state-of-the-art" High Definition system, which provides the most accurate information and is well totlerated by most patients.
Barium Swallow and Upper GI X-rays are commonly used to evaluate the esophagus and stomach. While they provide helpful information about the anatomy, these imaging studies offer little useful information about the function of these organs. Likewise, a CT scan of the chest and abdomen may be very helpful in identifying and measuring a hiatal hernia, it is not very helpful in determining the presence or extent of reflux disease.