Kawai et al (2010) reported that ultra-thin trans-nasal EGD (TN-EGD) reduces pharyngeal discomfort and is more tolerable for the patients. Ultra-thin transnasal endoscopy has been reported as inferior to transoral conventional EGD (TO-EGD) in terms of image quality, suction, air insufflation and lens washing, due to the smaller endoscope caliber; TN-EGD should be conducted slowly, with short distance observation, and also with image-enhanced endoscopy. With reference to image-enhanced endoscopy, chromoendoscopy method (indigocarmine) is suitable for gastric neoplasm. On the other hand, optical digital method (NBI) and digital method (i-scan, FICE) is suitable for esophageal neoplasm. TN-EGD is applied in various GI procedures such as percutaneous endoscopic gastrostomy, naso-enteric feeding tube placement, endoscopic retrograde cholangiopancreaticography with naso-biliary drainage, long intestinal tube placement in small bowel obstruction, as well as esophageal manometry.