Transnasal endoscopy (TNE) is a way of looking at your food pipe and stomach with a very thin camera passed through your nose instead of your mouth. More UK hospitals now offer it, and many people find it much easier than a standard gastroscopy. This guide explains what happens, how it feels, how it compares with a standard gastroscopy, and who it suits.
Key points
- TNE uses a camera about 5 to 6mm wide, roughly the width of a pencil, passed gently through the nose.
- It’s done with a numbing spray and gel, without sedation. You stay awake and can usually talk during the test.
- Because the camera doesn’t press on the back of the tongue, most people gag much less than with a standard gastroscopy.
- You can usually drive, work and go about your day once the numbness wears off, after about an hour.
- It isn’t suitable for every reason for a gastroscopy, for example some treatments or active bleeding.
What is transnasal endoscopy?
TNE looks at the same areas as a gastroscopy: your food pipe (oesophagus), stomach and the first part of the small bowel (duodenum). The difference is the route and the size of the camera. A standard gastroscope is about 9 to 10mm wide and goes through the mouth. A transnasal scope is about half that width and goes through the nose.[1]
It can be used to investigate indigestion, reflux, swallowing problems and iron deficiency anaemia, to check for coeliac disease, and to keep an eye on conditions such as Barrett’s oesophagus.[1,3] Small samples (biopsies) can be taken during the test, painlessly.
TNE and standard gastroscopy compared
| Transnasal endoscopy | Standard gastroscopy | |
|---|---|---|
| Route | Through the nose | Through the mouth |
| Camera width | About 5 to 6mm | About 9 to 10mm |
| Comfort options | Numbing spray and gel | Throat spray, sedation, or both |
| Gagging | Usually much less | More common |
| Talking during the test | Usually possible | Not possible |
| Biopsies | Yes | Yes |
| Treatments, such as stopping bleeding or stretching a narrowing | Usually not | Yes |
| Driving afterwards | Yes, once the numbness wears off | Not for 24 hours if you have sedation |
In a randomised trial comparing different approaches, people who had a thin scope through the nose were more likely to say the test was better than they had expected than people who had a standard scope, and image quality and biopsies were similar.[4] The thinner scope has less powerful suction, which is one reason a standard gastroscopy is still used when treatment might be needed.
Why some people prefer it
- Less gagging, because the scope doesn’t press on the back of the tongue.
- No sedation, so no need for someone to collect you or stay with you.
- You can talk during the test and tell the team how you’re doing.
- You can drive and go back to work the same day.
Who it may not suit
- People who need treatment during the test, such as stretching a narrowing or stopping bleeding. A standard gastroscopy is used instead.
- People with a very narrow nose, a badly bent nasal septum, recent nose surgery, or frequent nosebleeds.
- People who would prefer sedation. TNE is usually done without it.
Occasionally the scope can’t pass comfortably through the nose. In the trial above, this happened in about 1 in 11 people.[4] If so, the team may try the other nostril or pass the thin scope through the mouth instead.
If you take blood thinners or have diabetes, contact the endoscopy unit before your appointment, as you may need specific advice.[1]
Before the test
- Don’t eat for at least 6 hours before. Most units allow clear fluids, such as water or black tea, until about 2 hours before. Follow your appointment letter exactly.[1]
- Some units ask you to stop acid-reducing tablets such as omeprazole for 2 weeks before a first test, so inflammation and H. pylori aren’t hidden. Check your letter.[1]
- You may be given a small drink of simethicone (an anti-foaming liquid) shortly before, to clear bubbles from the stomach.[1]
What happens during the test
- A nurse checks your details and medicines and talks you through the test. You’ll be asked to sign a consent form.
- A numbing spray is sprayed into your nose and the back of your throat, and some lubricating gel is put into your nostril. This reduces discomfort and makes it easier to swallow.
- You sit upright or lie on your side. The thin scope is passed gently through your nose and down into your food pipe. You’ll be asked to swallow as it goes down.
- Air is gently blown in so the lining can be seen clearly. You may feel bloated or want to burp.
- The test itself usually takes about 5 to 10 minutes.
Why we set up a TNE service
I co-led the development of the transnasal endoscopy service at the healthcare facility where I work, alongside a consultant colleague. We launched it in November 2025, and we’ve now carried out hundreds of procedures. I also keep track of our data, so we can check the service is safe and working well.
The two biggest benefits people notice are that they often don’t gag or retch, and that they can talk to us and ask questions throughout the test.
We do TNE with numbing spray only, so people are wide awake. The spray tastes bitter and makes your throat feel thick, and for many people that’s the strangest part. Breathing slowly and steadily through your mouth while the scope passes makes a real difference.
If you’ve struggled with a standard gastroscopy before, or the thought of one has put you off, it’s worth asking whether TNE is an option for you.
Ben JohnsonAdvanced Clinical Practitioner, Gastroenterology
After the test
- Don’t eat or drink for about an hour, until the numbness wears off and you can swallow normally.[1]
- You may have a blocked or slightly sore nose, a sore throat or mild bloating for up to a day.
- You can drive and return to work once the numbness has gone.
Risks
TNE is very safe. Figures from NHS patient information include:[1]
| Risk | How often |
|---|---|
| Minor nosebleed | Up to 5 in 100 |
| Sinus infection (sinusitis) | Fewer than 1 in 100 |
| Inflammation of the tear duct | Fewer than 1 in 1,000 |
| Bleeding or a tear (perforation) in the food pipe | Fewer than 1 in 10,000 |
As with any camera test, a small abnormality can occasionally be missed.
Contact the endoscopy unit, NHS 111 or your GP if, after your test, you have:
- a nosebleed that won’t stop after 15 minutes of pressing the soft part of your nose
- pain in your chest, neck or tummy that is getting worse
- a high temperature, or difficulty swallowing that is getting worse
If you are vomiting blood or have severe pain, call 999 or go to A&E and tell them you’ve had an endoscopy.
Results
The person doing your test will usually tell you what they saw before you leave, and you’ll get a written report. If biopsies were taken, results usually take a few weeks and are sent to you and your GP, or discussed at a clinic appointment.[1]
Frequently asked questions
Does TNE hurt?
Most people describe it as uncomfortable rather than painful. The numbing spray helps a lot.
Is TNE as good as a normal gastroscopy?
For looking at the lining and taking biopsies, it works well for most reasons a gastroscopy is done. Your team will advise if a standard gastroscopy would be better for you.
Can I have sedation with TNE?
Usually not. If you’d prefer sedation, ask about a standard gastroscopy instead.
Can I ask for TNE instead of a gastroscopy?
You can ask. Not every hospital offers it, and it isn’t suitable for every reason for the test, but many units are happy to discuss it.
References
- University Hospitals Birmingham NHS Foundation Trust. Having a transnasal endoscopy (patient information). https://www.uhb.nhs.uk/media/5tck2pvp/pi-endoscopy-having-a-transnasal-endoscopy.pdf
- NHS. Gastroscopy. https://www.nhs.uk/tests-and-treatments/gastroscopy/
- Beg S, Ragunath K, Wyman A, et al. Quality standards in upper gastrointestinal endoscopy: a position statement of the British Society of Gastroenterology and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland. Gut 2017;66:1886–1899.
- Trevisani L, Cifalà V, Sartori S, et al. Unsedated ultrathin upper endoscopy is better than conventional endoscopy in routine outpatient gastroenterology practice: a randomized trial. World Journal of Gastroenterology 2007;13(6):906–911. https://www.wjgnet.com/1007-9327/full/v13/i6/906.htm