Topical anesthesia for transnasal esophagogastroduodenoscopy: spray, applicator, or both?

Transnasal esophagogastroduodenoscopy (EGD) has become widely accepted in Japan. Better performance and compliance for the procedure are expected with appropriate nasal anesthesia.We aimed to elucidate the effectiveness, the safety and the compliance of nasal anesthesia for transnasal EGD.

Subjects were 372 asymptomatic patients examined by transnasal EGD for gastric cancer screening. They were pretreated with topical anesthesia either with a nasal spray method (Spr group, n = 127), cotton-tipped applicator method (Cot group, n = 115), or both (Com group, n = 130). Lidocaine (4%) was applied with atomizer in the Spr method, whereas a cotton-tipped applicator soaked in 4% lidocaine was placed in the nasal cavity for 5 min in the Cot method. After transnasal EGD, each subject rated procedure-related discomfort according to visual analogue scales. In subjects who had prior experience of transoral EGD, tolerance against EGD was compared between transnasal and transoral routes.

There were no severe adverse events related to topical anesthesia.Transnasal EGD was completed in 94.9% of the patients.Age, gender or insertion failure rate were not different among Spr, Cot and Com groups. Pain scores for anesthesia and examination were significantly lower in the Spr group, whereas the pain score for insertion was not different among the three groups.The rate of patients who deemed transnasal EGD to be more tolerable than transoral EGD was highest in the Spr group.

Topical nasal spray seems to be appropriate for topical anesthesia in transnasal EGD.