A comparison of the upright seated versus left lateral decubitus position during pediatric sedation‐free transnasal endoscopy

Abstract Objectives Although sedation‐free transnasal endoscopy (TNE) is conventionally performed in an upright seated position in pediatric patients, emerging data suggest that the left lateral decubitus (LLD) position may improve both endoscopic visualization and patient comfort and safety. This study compared TNE outcomes and tolerance in pediatric patients using the upright versus LLD position. Methods A retrospective review was conducted on 110 pediatric patients who underwent sedation‐free TNE from September 2024 to November 2025. Three cases were excluded for scope failure during the procedure. Data including patient demographics, procedure time, TNEase (patient tolerance) score, and adverse events were collected. Results Of the 107 cases, 71 were performed upright, 31 LLD, and 5 converted from upright to LLD due to syncope. Four cases of emesis and two cases of minor epistaxis occurred during upright TNE, while no major adverse events occurred during LLD TNE. There were no significant differences between upright and LLD TNE in patient age (upright 13.8 ± 2.8 vs. LLD 12.5 ± 3.3 years), mean TNEase score (1.1 vs. 1.4), or procedure times. For TNE‐esophagoscopy, mean procedure times were 5.1 ( n = 55) and 5.5 min ( n = 27) in the upright versus LLD position, respectively. Times were 6.1 ( n = 12) versus 6.8 min ( n = 4) for TNE‐esophagogastroscopy, and 17.7 ( n = 4) versus 17.4 min ( n = 5) for TNE‐esophagogastroduodenoscopy. Conclusions The LLD position is a safe and effective alternative to upright TNE and is better tolerated in patients with orthostatic intolerance.