Duke Children’s is the first center in North Carolina, South Carolina, Georgia, and Virginia to offer transnasal endoscopy (TNE) for pediatric patients using the EvoEndo® Model LE Gastroscope (EvoEndo, Inc., Centennial, CO). The system allows visualization of the upper digestive tract to observe, diagnose, and treat conditions of the esophagus and stomach in patients ages five and older. TNE is performed during an office procedure and doesn’t require general anesthesia. 

John Lyles, MD, pediatric gastroenterologist, led the effort to bring TNE to Duke Children’s. “TNE is an exciting development in our specialty. Kids with certain digestive conditions have frequent upper endoscopies to monitor their disease and treatment plans. TNE is a more convenient option that decreases long-term exposure to general anesthesia.”

While a traditional endoscopy under general anesthesia requires hours in the hospital and a whole day of restricted activity, TNE is a short, procedure performed with just a local anesthetic. “Kids can return to school or their usual activities immediately,” says Lyles.

TNE is equally effective in visualizing the esophagus and parts of the stomach compared to traditional endoscopy. “With TNE, we only use lidocaine for comfort during the procedure,” says Lyles. “There may be slight discomfort, but after the scope is removed that goes away.” 

TNE is indicated for pediatric patients over age five; however, the child must stay calm and remain still for the procedure, which generally lasts 10 minutes or less. “Some young patients can tolerate TNE quite well, and we have VR goggles and other strategies to support them during the procedure. Adolescent patients typically do great with it,” says Lyles. 

Pediatric patients with chronic digestive conditions can significantly benefit from having TNE as an option. “Kids with eosinophilic esophagitis (EOE), dysphasia, heartburn or GERD, or H. pylori may need endoscopies regularly, and TNE may be good for them.”

Lyles notes it’s important for referring community pediatric providers and clinicians to know that Duke Children’s offers TNE. “If you have patients with digestive conditions or suspect a problem with the esophagus, you can feel confident referring them to our team. We can discuss options and support your patients in making the most informed decisions about their care,” says Lyles.

Lyles and his team are committed to expanding TNE at Duke Children’s. “Internally, we’re collaborating with other specialists, like pediatric hepatologists, who frequently order endoscopy as a diagnostic tool. This service can help their patients too,” says Lyles. 

To expand access and the team’s expertise, Lyles is training other pediatric gastroenterologists and fellows to perform TNE. 

“We’re committed to applying TNE with the best standards of evidence-based care,” says Lyles. “TNE visualizes the esophagus and some parts of the stomach well. In the future, we hope to use it to see more parts of the stomach and duodenum to diagnose and monitor more pediatric digestive disorders.”