Comparison of oral breathing vs. nasal breathing in unsedated peroral endoscopy

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Created On: 24/09/2025

This randomized controlled trial (RCT) compared oral breathing and nasal breathing during both ultrathin endoscopy (UE) and conventional endoscopy (CE) to determine their effects on endoscopic performance and patient experience.

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Key take away

Compared to nasal breathing, oral breathing markedly improves endoscopic operability in peroral endoscopy, making unsedated endoscopy with oral breathing the preferred option in routine practice.

Background

Method

In total, 252 eligible patients scheduled for either UE or CE were randomly assigned to practice oral breathing or nasal breathing. Utilizing a 100-mm visual analog scale (VAS), both patients and endoscopists evaluated endoscopic maneuverability and tolerance. Additionally, visibility from the oral cavity to the mid-pharynx was documented.

Result

As opposed to nasal breathing, oral breathing resulted in better visibility from the oral cavity to the mid-pharynx in 79.3% to 81.0% of cases. Multivariate correlation analysis revealed that oral breathing was linked with markedly better endoscopic operability, reflected by lower VAS scores, in both UE and CE groups.

Although the overall patient tolerance did not considerably differ between oral breathing and nasal breathing within each endoscopy type, patients reported better comfort with UE than with CE. As per discriminant analysis, UE + OB attained the highest overall ratings for both patient tolerance and operability.

Conclusion

In peroral endoscopy, oral breathing enhances endoscopic operability when compared to nasal breathing. Hence, the use of UE with OB appears to be the optimal approach for unsedated peroral endoscopy in routine clinical practice.