Topical pharyngeal anesthesia improves tolerance of upper gastrointestinal endoscopy: a randomized double-blind study

The usefulness of topical pharyngeal anesthesia is not well established. The aim of the present study was to determine its benefits in relation to patient tolerance and facilitation of the procedure in unsedated patients undergoing upper gastrointestinal endoscopy.

A randomized double-blind study comparing Topicaina spray - a mixture of benzocaine butyl aminobenzoate (butoforme), amethocaine, and butacaine - and a placebo was carried out on 256 outpatients referred for diagnostic endoscopy. No additional premedication was used. After the examination, both the tolerance to and difficulty of the intubation and examination were evaluated by patients and endoscopists respectively, using visual analogue scales and a questionnaire.

Three patients (1.2%) did not tolerate the endoscopy. One patient was excluded for unexpected therapeutic endoscopy. One hundred twenty-five patients received the active spray and 127 received the placebo. The two groups were similar with respect to patient characteristics. Both intubation and examination, assessed with visual analogue scales, were better tolerated (both p = 0.0001) and more easily performed (p = 0.02 and p = 0.0001 respectively) in the active treatment group. Patients receiving the active spray had a better tolerance for the procedure, according to questionnaire replies.

Topical pharyngeal anesthesia in unsedated patients undergoing diagnostic upper gastrointestinal endoscopy improves tolerance and makes examination easier.