Effects of hard candy on saliva production and gastric fluid volume: implications for safe endoscopy

Patients presenting for endoscopic procedures consuming or having recently consumed hard candy may have their procedures delayed or canceled because of concern for aspiration. Our aim is to determine the time needed after ingestion of hard candy for the safe performance of sedated endoscopy.

A 2-phase institutional review board-approved study was performed. In phase 1, healthy adults collected their oral secretions before and after ingestion of hard candy to measure the impact of hard candy on saliva production. In phase 2, patients undergoing clinical upper endoscopy were randomized to receive hard candy (HC group) or not receive hard candy (no-HC group) approximately 30 minutes before endoscopy. Blinded endoscopists aspirated gastric fluid immediately after gastric intubation and measured its volume and weight. Participants were assessed for adverse events.

Ten healthy volunteers (6 women; median age, 28 years) were enrolled in phase 1. Saliva production peaked at the collection 10 minutes after initiating hard candy. The mean time from candy completion for saliva production to return to within 10% of unstimulated levels was 32 minutes (standard deviation, 12). In phase 2, 63 participants were randomized and had gastric fluid volumes and weights measured. The mean gastric fluid volume was 23.3 mL in the HC group and 17.6 mL in the no-HC group (P = .21). No adverse events were attributable to study participation.

Our results suggest that endoscopic procedures can be safely performed after ingestion of hard candy and should not be delayed by more than 30 minutes.