The Provincial Health Services Authority is pleased to announce that a team that received funding through the provincial Ministry of Health’s Innovation Pathway Program, as part of its inaugural intake in early 2023, has completed its project with promising and potentially far-reaching results.
The project based at BC Children’s Hospital, called “Unsedated Trans-nasal Endoscopy (TNE) Using Virtual Reality,” adapted a procedure to collect esophageal biopsies which previously required full sedation done in the OR to a procedure that is being done ‘bedside’ without sedation in older children.
The project was led by Dr. Vishal Avinashi, Pediatric Gastroenterologist at BC Children’s, along with members from the Digital Lab (Brian Greeley, Eric Greaney, and John Jacob). Collaborators include Dr. Edmond Chan (Allergy), Dr. Neil Chadha (ENT), and Dr. Jon Bush (Pathology).
The 11 patients involved in this pilot project required follow-up esophageal biopsy to monitor their condition called Eosinophilic Esophagitis (EoE), which is an allergic inflammation of the esophagus which can result in food getting stuck and narrowing of the esophagus.
The launch of TNE, done between February 2024 and December 2024, implemented a smaller scope inserted through the nose into the esophagus without sedation while patients used virtual reality (VR) for comfort and distraction. Patients could both see and hear the video and respond to the clinical care team, when needed.
The same esophageal biopsies were obtained successfully using this arrangement as compared to the standard sedated esophagogastroduodenoscopy (EGD). These patients avoided prolonged fasting, IV placement, anaesthetic delivery, eliminated ‘recovery’ time and allowed a family member to stay in the room.
Patients, caregivers, and staff were highly satisfied with TNE and recommended the use of VR in future TNE procedures. All TNE patients reported being either satisfied (56%) or highly satisfied (44%). Five out of the seven TNE patients (71%) surveyed said their procedure was better. Six (86%) out of seven TNE patients surveyed said they would do the same procedure again.
Examples of the TNE setup with two different patients.
In general, project team members found that TNE offers a safe, well-tolerated, and patient- and caregiver-centred alternative to sedated EGD, delivering equivalent biopsy outcomes while reducing the need for operating room resources. Transitioning procedures out of the operating room (OR) builds capacity for more complex cases, while significantly reducing health-care costs.
“The option of Trans Nasal Endoscopy with Virtual Reality offers enormous potential and is an exciting option for patients with Eosinophilic Esophagitis.” - Dr. Vishal Avinashi, Project Lead
Following the completion of the pilot project, the team will continue to offer the treatment to appropriate patients, and will quantify the savings associated with the treatment for future planning.
For more information about the B.C. Ministry of Health's Innovation Pathways Program, please
visit their homepage.
