Upper gastrointestinal disorders are most commonly diagnosed with esophagogastroduodenoscopy (EGD). In EGD, hypoxia due to conscious sedation is a significant cause of mortality and morbidity. As a result of sedation use, the cost of endoscopy increases, the patient misses work the day of the procedure, and he or she must be accompanied home afterwards. Endoscopic transnasal surgery offers several advantages over conventional intraoral surgery, including less patient monitoring, less nursing time and lower costs. The purpose of this study was to determine if unsedated transnasal EGD is feasible and acceptably in daily practice. An oral or transnasal EGD with sedation was offered to patients due to undergo EGD. Patients who chose unsedated transnasal EGD were treated by an experienced gastroenterologist. Small-caliber esophagogastroduodenoscopies were used for all procedures. An anonymous patient satisfaction survey asked all patients to rate their level of discomfort from choking, sore throats, nasal discomforts, and abdominal discomfort according to a set of criteria. Each variable was rated from 0 to 10, with 10 being the most severe. It was also noted if there were any complications. There were 200 trans nasal EGDs performed. Patient age ranged from 16 to 88 years (median 55). 96% of patients could undergo a complete examination. It was considered acceptable (mean score 5.4, range 1 to 10) and caused little discomfort in terms of choking sensations (mean 2.8, range 0 to 10) nasal discomfort (mean 1.9, range 0 to 10) sore throats (mean 1.2, range 0 to 9) and abdominal discomfort (mean 1.4, range 0 to 10) by patients. There were only two (0.6%) and one (0.8%) reported complications (epistaxis and sinusitis). In addition, patients reported feeling lightheaded for a brief period of time (n=12, 5%) and experiencing mucous discharge (n=2, 0.6%). Of the 185 patients (88%) who completed the study, 85% said they would undergo the same procedure again if medically necessary. In contrast to 84 patients who previously underwent conventional EGD under conscious sedation, 52 patients (62%) preferred transnasal EGD without sedation. There is generally good tolerance, feasibility and safety with transnasal EGD. Topical anesthesia can be used in an outpatient setting. Compared to conventional EGD for screening upper gastro-intestinal tract diseases, transnasal endoscopy offers low complication rates, high patient satisfaction and potential cost savings.