Abstract
Background and study aims It is important to examine the pharynx during
upper gastrointestinal endoscopy. Pharyngeal anesthesia using topical lidocaine
is generally used as pretreatment. In Japan, lidocaine viscous solution is the
anesthetic of choice, but lidocaine spray is applied when the former is
considered insufficient. However, the relationship between the extent of
pharyngeal anesthesia and accuracy of observation is unclear. We compared the
performance of lidocaine spray alone versus lidocaine spray combined with
lidocaine viscous solution for pharyngeal observation during transoral
endoscopy.
Patients and methods In this prospective, double-blinded, randomized
clinical trial conducted between January and March 2015, 327 patients were
randomly assigned to lidocaine spray alone (spray group, n = 157) or a
combination of spray and viscous solution (combination group, n = 170). We
compared the number of pharyngeal observable sites (non-inferiority test), pain
by visual analogue scale, observation time, and the number of gag reflexes
between the two groups.
Results The mean number of images of suitable quality taken at the
observable pharyngeal sites in the spray group was 8.33 (95 % confidence
interval [CI]: 7.94 – 8.72) per patient, and 8.77 (95 % CI: 8.49 – 9.05) per
patient in the combination group. The difference in the number of observable
pharyngeal sites was – 0.44 (95 % CI: – 0.84 to – 0.03, P = 0.01). There
were no differences in pain, observation time, or number of gag reflexes between
the 2 groups. Subgroup analysis of the presence of sedation revealed no
differences between the two groups for the number of pharyngeal observation
sites and the number of gag reflexes. However, the number of gag reflexes was
higher in the spray group compared to the combination group in a subgroup
analysis that looked at the absence of sedation.
Conclusions Lidocaine spray for pharyngeal anesthesia was not inferior to
lidocaine spray and viscous solution in terms of pharyngeal observation. It was
considered that lidocaine viscous solution was unnecessary for pharyngeal
observation. UMIN000016073
Lidocaine
spray alone is similar to spray plus viscous solution for pharyngeal observation
during transoral endoscopy: a clinical randomized
trial
