Upper endoscopy is an integral component in the management of upper gastrointestinal disorders, but it is underutilized because of its high cost and potential complications. Unsedated transnasal endoscopy (T-EGD) is a relatively new technique using an ultrathin endoscope. Because it is better tolerated than standard upper endoscopy, it is performed with the patient unsedated, thus avoiding the associated costs and complications of conscious sedation. In this review, the technique of T-EGD and its current experience are discussed. In addition, potential future applications, special considerations, and potential pitfalls are reviewed.