Upper endoscopy is an invasive procedure. However, the benefits of routinely administered sedative medication or topical pharyngeal anesthetic are controversial.
Dr Ristikankare and colleagues from Finland undertook a study in order to clarify the effects of sedative medication and topical anesthetic on patient tolerance and difficulty of upper endoscopy.
The researchers included a total of 252 patients who were scheduled for diagnostic upper endoscopy in the study.
The participants were randomly assigned to 4 groups:
(1) sedation with midazolam and placebo pharyngeal spray (midazolam group),
(2) placebo sedation and lidocaine pharyngeal spray (lidocaine group),
(3) placebo sedation and placebo pharyngeal spray (placebo group), and
(4) no intravenous cannula/pharyngeal spray (control group).
The endoscopist and the patient assessed the procedure immediately after the examination.
The researchers then sent another questionnaire was sent to the patients 2 weeks later.
The research team found that patients in the midazolam group rated the examination easier and less uncomfortable compared with those in the other groups.
|Endoscopists found intubation to be more difficult in sedated vs. non-sedated patients|
The differences were especially evident in the questionnaires completed 2 weeks after the examination.
In addition, the researchers found that lidocaine did not significantly improve patient tolerance.
However, endoscopists found the procedure easier in patients in the lidocaine group compared with the midazolam and control groups but not the placebo group.
Routine administration of midazolam for sedation increased patient tolerance for upper endoscopy.
However, endoscopists found intubation to be more difficult in sedated vs. non-sedated patients.
Dr Ristikankare concluded, "Topical pharyngeal anesthesia did not enhance patient tolerance."
"However, it did make upper endoscopy technically easier compared with endoscopy in patients sedated with midazolam without topical pharyngeal anesthesia."
"It also made endoscopy easier in patients who had no sedation or pharyngeal anesthesia, but not in patients who received placebo sedation and placebo pharyngeal anesthesia."