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.