Lidocainespray alone is similar to spray plus viscous solution for pharyngeal observationduring transoral endoscopy: a clinical randomizedtrial

摘要

>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 theobservable pharyngeal sites in the spray group was 8.33 (95 % confidenceinterval [CI]: 7.94 – 8.72) per patient, and 8.77 (95 % CI: 8.49 – 9.05) perpatient in the combination group. The difference in the number of observablepharyngeal sites was – 0.44 (95 % CI: – 0.84 to – 0.03, P = 0.01). Therewere no differences in pain, observation time, or number of gag reflexes betweenthe 2 groups. Subgroup analysis of the presence of sedation revealed nodifferences between the two groups for the number of pharyngeal observationsites and the number of gag reflexes. However, the number of gag reflexes washigher in the spray group compared to the combination group in a subgroupanalysis that looked at the absence of sedation. >Conclusions Lidocaine spray for pharyngeal anesthesia was not inferior tolidocaine spray and viscous solution in terms of pharyngeal observation. It wasconsidered that lidocaine viscous solution was unnecessary for pharyngealobservation. UMIN000016073