Controlled comparison of topical anesthetic agents in flexible upper gastrointestinal endoscopy

Topical anesthetics are generally part of the premedication associated with upper gastrointestinal endoscopy. Selection is not usually based on objective criteria. We performed a randomized study comparing six anesthetic agents: three sprays (Cetacaine, Hurricaine, and 10% Xylocaine spray) and three gargles (2% lidocaine, and two combinations of 2% lidocaine diluted 1:1 with mouthwash). Normal subjects, experienced in undergoing gastroscopy, underwent repeated upper gastrointestinal endoscopic examinations with a 34 F Pentax fiberscope. Topical anesthetic was the only premedication used. The parameters evaluated by the subjects were taste, effectiveness of anesthesia, and ease of scope passage. At the end of the trial each subject ranked the agents in order of preference. Although subjects differed in their preference for the different anesthetic agents (sometimes significantly), there was no single parameter such as taste, degree of anesthesia, or ease of passage of the endoscope that could be correlated with overall preference. All agents gave acceptable levels of local anesthesia, although there was a distinct subjective preference for spray forms. We recommend that if a local anesthetic is used, it should be one of the spray formulations. This recommendation is based on safety, the relative ease of application, and the lack of profound differences between agents.