Background <p>Children diagnosed with eosinophilic esophagitis (EoE) often require repeated esophagogastroduodenoscopy (EGD) procedures to monitor disease progression and treatment response. These procedures typically involve general anesthesia, which is associated with short-term side effects and potential long-term risks. Transnasal endoscopy (TNE) has emerged as a less invasive alternative to EGD that can be performed without anesthesia. The use of virtual reality (VR) during TNE eliminates anesthesia exposure in patients requiring repeated EGD, while enhancing patient comfort and procedural success.</p> Case presentations <p>The objective of this case study is to detail the experience of a 12-year-old, Caucasian, male patient diagnosed with EoE. The patient previously underwent multiple EGD procedures to monitor disease progression, resulting in repeated anesthesia exposures. In hopes of reducing anesthesia exposure, the patient and their family opted to explore sedation-sparing alternatives to EGD, marking the patients first TNE. Despite high baseline anxiety, the patient tolerated their initial TNE procedure without vomiting or gagging, required less than one hour in the clinic per visit, experienced no post-procedural recovery time, and requested VR for follow-up TNE procedures. Utilizing VR enabled a successful, sedation-free TNE in a highly anxious pediatric patient, supporting VR as an effective sedation-sparing substitute for painful procedures.</p> Conclusions <p>This case highlights the potential of VR as a non-pharmacologic tool to enhance the tolerability of TNE in pediatric patients, thereby minimizing sedation-associated health risks in children requiring frequent endoscopic monitoring.</p>