Reply to Hu

It is important to know the frequency of epistaxis as one of the most common complications of ultrathin transnasal esophagogastroduodenoscopy (UT-EGD) to assess the safety of the procedure. Although there are a number of reports on epistaxis [1], the frequency of this complication largely varies. Such variance may result from lack of a grading standard of epistaxis occurring during UT-EGD. Particularly, as Dr. Hu mentions, the distinction between confined and unconfined hemorrhage is of great significance. Therefore, we have proposed to describe “confined” and “unconfined” hemorrhage as “oozing” and “overt” hemorrhage, respectively. We have encountered only a few cases in which oozing hemorrhage became overt bleeding, and most cases in which blood came out from the nostril and/or drained into the hypopharynx have been diagnosed as overt bleeding. Therefore, we believe that our grading is sufficient to establish the frequency and grade of epistaxis. Moreover, it would be stressful to patients to increase the session time in order to observe the nasal mucosa at the end of a routine EGD procedure. Of course, we agree that the recording of the “how” and “where” for nasomucosal injury is useful. According to our recent multicenter study (1862 patients enrolled), oozing (grade 2) and overt hemorrhage (grade 3) occurred in 7.8 % and 1.5 % of patients, respectively. The locations of bleeding were the middle turbinate (78 %), the inferior turbinate (15 %), and the nasal septum (6 %). We have never experienced bleeding at Kiesselbach’s plexus (Mori A. et al., unpublished observations).

Competing interests: None

References

• 1 Tatsumi Y, Harada A, Matsumoto T. et al . Current status and evaluation of transnasal esophagogastroduodenoscopy.  Dig Endosc. 2009;  21 141-146