How we do it: Transnasal fibreoptic oesophagoscopy

Keypoints • Transnasal fibreoptic oesophagoscopy (TFO) allows the upper aerodigestive tract, from the nasal vestibule to the gastric cardia to be examined in the outpatients department without sedation. • This permits patients with symptoms of upper aerodigestive pathology to be investigated at the initial consultation without the need for inpatient endoscopy or swallow studies. • The technique is easily learned, and is statistically comparable with standard flexible nasoendoscopy in respect of procedural pain and discomfort. • It is highly cost‐efficient, paying for itself within 1 year, and thereafter leading to cost savings of over 80%. • Its role can be expanded to encompass investigating patients with potentially malignant disease processes, as well as outpatients ‘panendoscopy’ and biopsy, and a number of therapeutic interventions.