Posterior lingual lidocaine: a novel method to improve tolerance in upper gastrointestinal endoscopy

Abstract

Aim: To evaluate the effect of posterior lingual lidocaine swab on patient tolerance to esophagogastroduodenoscopy, the ease of performance of the procedure, and to determine if such use will reduce the need for intravenous sedation.

Methods: Eighty patients undergoing diagnostic esophagogastroduodenoscopy in a tertiary care medical center were randomized to either lidocaine swab or spray. Intravenous meperidine and midazolam were given as needed during the procedure.

Results: Patients in the lidocaine swab group (SWG) tolerated the procedure better than those in the spray group (SPG) with a median tolerability score of 2 (1, 4) compared to 4 (2, 5) (P < 0.01). The endoscopists encountered less difficulty performing the procedures in the SWG with lower median difficulty scores of 1 (1, 5) compared to 4 (1, 5) in the SPG (P < 0.01). In addition, the need for intravenous sedation was also lower in the SWG compared to the SPG with fewer patients requiring intravenous sedation (13/40 patients vs 38/40 patients, respectively, P < 0.01). The patients in the SWG were more satisfied with the mode of local anesthesia they received as compared to the SPG. In addition, the endoscopists were happier with the use of lidocaine swab.

Conclusion: The use of a posterior lingual lidocaine swab in esophagogastroduodenoscopy improves patient comfort and tolerance and endoscopist satisfaction and decreases the need for intravenous sedation.

Keywords: Esophagogastroduodenoscopy; Lidocaine; Local anesthesia; Sedation; Upper gastrointestinal endoscopy.

Figure 1

The gag reflex pathway: afferent fibers from the trigger areas in the pharynx and tongue carried by the glossopharyngeal nerve (cranial nerve XI) to the nucleus solitarus which sends the input to the nucleus ambiguus in the medulla oblongata. Efferent fibers from the nucleus ambiguus carried via the vagus nerve (CN X) to the pharyngeal constrictors to contract and cause gagging. CN: Cranial nerve.