This paper looked at 257 patients undergoing the procedure in a tertiary otolaryngology department. In light of the morbidity of upper GI endoscopy associated with the sedation required, the safety profile of transnasal oesophagoscopy is a clear advantage. This cohort demonstrated a 97% success rate with poor view preventing diagnosis in only 1% of cases. Most common indications were unexplained throat symptoms and dysphagia. Following transnasal oesophagoscopy 56% patients had no detectable abnormality, allowing discharge to primary care or referring specialty. Positive findings were most commonly of GI pathology including hiatus hernia, Barretts oesophagus and dysmotility. This procedure appears likely to significantly evolve patient care over the coming years and appears in trained hands a safe and diagnostically sensitive tool.