Lidocaine Spray Versus Viscous Lidocaine Solution Plus Lidocaine Spray in Patients Undergoing Non‐Sedated Esophagogastroduodenoscopy: A Randomized Controlled Trial

Abstract

ABSTRACT Background Non‐sedated esophagogastroduodenoscopy (EGD) is preferred in patients at risk from sedatives. However, achieving effective pharyngeal anesthesia remains a challenge. This study compared lidocaine spray alone with a combination of lidocaine spray and viscous lidocaine solution. Methods This single‐center, randomized controlled trial was conducted between January 2024 and October 2024 at Sawanpracharak Hospital, Thailand. A total of 250 patients undergoing non‐sedated EGD were randomized to receive lidocaine spray alone (S group, n = 125) or lidocaine spray plus viscous lidocaine (S + V group, n = 125). The primary outcome was procedural pain measured using a visual analog scale (VAS, 0–10) immediately after completion of the procedure. Secondary outcomes included patient satisfaction, endoscopist satisfaction, ease of intubation, tolerance, and adverse events. Results Baseline characteristics were comparable between groups. The S + V group reported significantly lower procedural pain than the S group (mean VAS 1.6 ± 1.1 vs. 3.1 ± 1.7; p = 0.01). Patient satisfaction was higher in the S + V group (very satisfied: 23.2% vs. 12.8%; p = 0.016). Ease of intubation was also improved (effortless intubation: 43.2% vs. 29.6%; p = 0.030). Endoscopist satisfaction numerically favored the S + V group but did not reach statistical significance (p = 0.070). No serious adverse events were observed. Conclusion Combining lidocaine spray with viscous lidocaine solution significantly reduced procedural discomfort and improved procedural conditions during non‐sedated EGD compared with lidocaine spray alone. Trial Registration ClinicalTrials.gov identifier: NCT06185933