Topical viscous lidocaine solution versus lidocaine spray for pharyngeal anesthesia in unsedated esophagogastroduodenoscopy

Background and study aims: Pharyngeal anesthesia using topical lidocaine is generally used as pretreatment for unsedated esophagogastroduodenoscopy (UEGD). The aim of this study was to compare and evaluate the clinical efficacy of topical Viscous lidocaine solution and lidocaine spray when each is used as a single agent for UEGD. Patients and methods: Patients were randomized into the viscous lidocaine (V) group (n=930) or the lidocaine spray (S) group (n=934). The total dose of lidocaine was not higher than 5 mg/kg. The primary objective was to measure the successful completion rate of the endoscopy. The secondary objectives were to assess patient and endoscopist satisfaction, procedural pain, patient tolerance, ease of intubation, and adverse events. Results: The procedure was successfully completed in 868 patients from group V (93.3%) and 931 patients from group S (99.7%: P < 0.001). Patients and endoscopists reported a higher degree of satisfaction in group S than group V (P < 0.0001). Procedural pain score in group S was significantly lower than in group V (P < 0.0001). The endoscopist rated patients in group S as having better tolerance and ease of intubation than those in group V (P = 0.0004 and P = 0.002, respectively). Adverse events occurred in 370 patients in group V and 316 patients in group S (P = 0.002). These were mainly transient changes in vital signs including hypertension, tachycardia, and bradycardia. Conclusions: The use of lidocaine spray in UEGD was shown to result in a higher procedural completion rate, greater ease of intubation, and greater patient and endoscopist satisfaction. Topical lidocaine spray may be a better form of pharyngeal anesthesia than Viscous lidocaine solution in UEGD.