Gauze pledgetting versus endoscopic-guided aerosolized spray for nasal anesthesia before transnasal EGD: a prospective, randomized study

Background

Methods and efficacy of nasal anesthesia before ultrathin transnasal EGD (UT-EGD) are crucial for patient tolerance.

Objective

To compare patient tolerance, safety, and adverse events between cotton-tipped applicator primed gauze pledgetting (CTGP) and endoscopic-guided aerosolized spray (EGAS) methods of nasal anesthesia.

Design

We performed a prospective, randomized-controlled trial to compare procedural discomforts, optical quality, total procedure time, and adverse events between the CTGP and EGAS methods.

Setting

A large, tertiary referral hospital in Taiwan.

Patients

A total of 240 consecutive patients with epigastric discomfort were included in the study.

Intervention

The author performed all standardized nasal anesthesia and UT-EGD using a 5.9-mm diameter transnasal endoscope.

Main Outcome Measurements

Technical success, patient tolerability profiles, optical quality, total procedure time, and adverse events.

Results

There was no statistical difference in insertion failure rates between the 2 methods (CTGP 0% vs EGAS 5%, P = .07). When compared with the EGAS method, CTGP reduced pain during insertions through the inferior nasal meatus (3.4 ± 0.5 vs 3.2 ± 0.4, P = .006), middle nasal meatus (4.0 ± 0.7 vs 3.4 ± 0.5, P = .002), and upper esophageal sphincter (2.9 ± 0.7 vs 2.6 ± 0.8, P = .005). CTGP elicited less unpleasant taste, fewer gagging episodes, and less throat pain after examination. Both methods had similar safe hemodynamic profiles, low epistaxis rates (0% vs 2%, P = .46), and comparable visual capacity and procedure time. Although similar proportions of patients in both groups would like to receive the same procedure the next time, CTGP had a higher overall tolerance.

Conclusion

Compared with the EGAS method, CTGP achieved a better tolerability profile and elicited less bad taste, fewer gagging episodes, and less throat pain after UT-EGD in Taiwanese patients.

Abbreviations: BMI, body mass index, CTGP, cotton-tipped applicator primed gauze pledgetting, CTNA, cotton-tipped applicator nasal anesthesia, EGAS, endoscopic-guided aerosolized spray, INM, inferior nasal meatus, INT, inferior nasal turbinate, MNM, middle nasal meatus, MNT, middle nasal turbinate, P-EGD, peroral EGD, UT-EGD, ultrathin transnasal EGD, VAS, visual analogue scale