S1062 Unsedated Transnasal Esophagogastroduodenoscopy in Lung Transplant Evaluation: A Safe and Tolerable Alternative to Conventional Endoscopy

Introduction: Patients with end-stage lung disease (ELD) face elevated risks of cardiopulmonary complications associated with sedation, limiting the use of conventional esophagogastroduodenoscopy (C-EGD) during pre-transplant evaluation. Unsedated transnasal esophagogastroduodenoscopy (T-EGD) is a minimally invasive, sedation-free alternative that may allow for evaluation of upper gastrointestinal (GI) pathology in this high-risk population. However, data on its use in ELD patients remain limited. This study aimed to assess the safety and tolerability of T-EGD in patients undergoing lung transplant evaluation. Methods: We retrospectively reviewed patients with ELD who underwent T-EGD between 2016 and 2024 as part of lung transplant evaluation, specifically for alarm symptoms or findings (e.g., dysphagia, severe dysmotility, or anatomic abnormalities). Patients were identified using Current Procedural Terminology codes for T-EGD, International Classification of Diseases-10 codes for pulmonary diseases, and ProVation endoscopy records. Those undergoing T-EGD for non-transplant indications were excluded. Tolerability and complications were evaluated via electronic medical record review. Results: A total of 16 patients met inclusion criteria; 63% were men with a median age of 63 years (interquartile range [IQR] 60-71) and median body mass index of 24.3 (IQR 20.2-27.6). All procedures were performed in the outpatient setting using topical anesthesia. The mean American Society of Anesthesiologists (ASA) physical status score was 3. Fourteen patients (88%) completed T-EGD without complications, defined as absence of significant vital sign changes or intolerable discomfort; the mean procedure time was 11.6 minutes. Actionable findings were identified in 86% of patients, including Hill grade ≥ III (79%), esophageal candidiasis (14%), Schatzki ring (14%), laryngeal reflux (14%), gross esophageal dysmotility (14%), Barrett’s esophagus (7%), esophagitis (7%), and gastritis (7%). One procedure was converted to unsedated peroral EGD due to nasal anatomical obstruction; another was aborted due to minor epistaxis. Conclusion: T-EGD was well tolerated in the majority of ELD patients undergoing lung transplant evaluation, with a high diagnostic yield of clinically actionable findings. These results support the safety and feasibility of T-EGD as an alternative to sedated endoscopy in this high-risk population. Further prospective studies are warranted to evaluate diagnostic accuracy, impact on transplant candidacy, and long-term graft outcomes.