Brief Article
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World J Gastroenterol. Dec 21, 2011; 17(47): 5191-5196
Published online Dec 21, 2011. doi: 10.3748/wjg.v17.i47.5191
Posterior lingual lidocaine: A novel method to improve tolerance in upper gastrointestinal endoscopy
Assaad M Soweid, Shadi R Yaghi, Faek R Jamali, Abdallah A Kobeissy, Michella E Mallat, Rola Hussein, Chakib M Ayoub
Assaad M Soweid, Shadi R Yaghi, Abdallah A Kobeissy, Michella E Mallat, Rola Hussein, Department of Internal Medicine, American University of Beirut Medical Center, 1107 2020 Beirut, Lebanon
Faek R Jamali, Department of Surgery, American University of Beirut Medical Center, 1107 2020 Beirut, Lebanon
Chakib M Ayoub, Department of Anesthesiology, American University of Beirut Medical Center, 1107 2020 Beirut, Lebanon
Author contributions: Soweid AM and Ayoub CM designed the study; Yaghi SR, Mallat ME and Hussein R collected the data; Jamali FR and Kobeissy AA analyzed and interpreted the data, and were also involved in editing the manuscript; Soweid AM and Ayoub CM wrote the paper.
Correspondence to: Dr. Chakib M Ayoub, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, 1107 2020 Beirut, Lebanon. ca04@aub.edu.lb
Telephone: +961-1-350000 Fax: +961-1-366098
Received: July 12, 2010
Revised: November 11, 2010
Accepted: November 18, 2010
Published online: December 21, 2011
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, Upper gastrointestinal endoscopy, Local anesthesia, Lidocaine, Sedation