Lidocaine Viscous Solution Appears Unnecessary for Pharyngeal Observation

Lidocaine spray alone for pharyngeal anaesthesia is not inferior to lidocaine spray and viscous solution, according to a study presented here at Digestive Disease Week (DDW) 2016.

The findings suggest that lidocaine viscous solution may not be needed for pharyngeal observation, according to Tomoyuki Hayashi, MD, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan, and colleagues.

Pharyngeal examination is important during upper gastrointestinal endoscopy, and a common pretreatment for this is pharyngeal anaesthesia using topical lidocaine.

Lidocaine viscous solution is the anaesthetic of choice in Japan, but when this is insufficient, lidocaine spray is used. However, it is still unclear whether the extent of pharyngeal anaesthesia is directly related to the accuracy of observation.

For the current study, researchers compared the performance of lidocaine spray alone versus lidocaine spray combined with lidocaine viscous solution for pharyngeal observation during transoral endoscopy.

The researchers randomised 327 patients to lidocaine spray alone or a combination of spray and viscous solution and compared the number of pharyngeal observable sites (non-inferiority test), pain by visual analogue scale, observation time, and the number of gag reflexes between the 2 groups.

The number of pharyngeal observable sites was not lower in the spray group than in the combination group (P = 0.01).

Furthermore, both groups showed similar results for pain, observation time, and number of gag reflexes.

However, a subgroup analysis of absence of sedation, the number of gag reflexes was higher in the spray group than in the combination group.

Digestive Disease Week 2016 is cosponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society for Surgery of the Alimentary Tract (SSAT).

[Presentation title: Lidocaine Spray Alone Is Similar to Lidocaine Spray Plus Viscous Solution for Pharyngeal Observation During Transoral Endoscopy: a Randomized Prospective Study. Abstract Sa1072]