[Use of topical pharyngeal anaesthesia in esophagogastroduodenoscopy in unsedated patients]

Evaluation of effect on tolerance of topical pharyngeal anaesthesia with a lidocaine spray in esophagogastroduodenoscopy (EGD), and possible secondary factors that could influence it.

A prospective, experimental, randomized, open-label study was performed in our Endoscopy Unit during January 2010. Outpatients (109) were recruited prospectively and randomized between two groups: L group (52), who received lidocaine (50 mg Xilonibsa 10% before examination), and C group (57) who did not. Sedated patients were not included in this study. Age, sex, Mallampati index (lower I and II; higher III and IV), endoscopist, complications and score (0-100; visual analogue scale) was recorded after each EGD.

There were no statistical differences between the two groups as regards patient tolerance. However in stratified analysis the application of lidocaine modified the results in two out of the six endoscopists and improved the scores in patients with a higher Mallampati Index (L group 61.8 ± 24 and C group 47.7 ± 32). Significant differences were also observed in the scores on patient tolerance between the endoscopist (operator dependent factor), regardless of the use of topical pharyngeal anaesthesia or not.

The systematic use of lidocaine in EGD is safe but does not improve the tolerance in all outpatients. Only the Mallampati index has been identified as a prognosis factor of good response to lidocaine administration. Additionally the nursing-endoscopist could be a very important factor in the scores obtained independently of lidocaine.