#34723 Lidocaine spray versus other forms for local anesthesia in upper gastrointestinal endoscopy: A systematic review and meta-analysis

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Background and Aims

Pharyngeal anesthesia before esophagogastroduodenoscopy (EGD) reduces pain and discomfort. Many forms of lidocaine are used as local anesthesia. However, it remains unclear which method is the best. We aimed to assess effective each lidocaine’s form during EGD compared with spray.

Methods

We searched PubMed, Scopus, EMBASE, the Cochrane Central Register of Controlled Trials, CENTRAL, Web of Science Core Collection, World Health Organization, International Clinical Trials Registry Platform, and ClinicalTrials.gov databases in December 2022. Selection criteria were randomized controlled trials comparing lidocaine spray with other forms (gel, lozenges, nebulized, popsicle, and viscous) in EGD. Outcomes of interest included ease of instrumentation, participants’ satisfaction scores, tolerance scores, or pain, endoscopist’s satisfaction scores, and procedural time.

Results

We included 13 trials with 3,711 participants undergoing EGD. The quality of trials was poor. Lidocaine spray provided better ease of instrumentation (Risk ratio (RR) 1.19, 95% confident intervals (CI)1.06,1.34;I2=66%;very low certainty of evidence), decreased participants’ pain (Mean difference (MD) 0.38, 95% CI 0.25,0.5;I2=92%;very low certainty of evidence), and shorter procedural time (MD 0.22, 95% CI 0.10,0.35;I2=13%;low certainty of evidence). However, spray had lower participants’ highest satisfaction scores (RR 0.83, 95% CI 0.76,0.92;I2=62%;very low certainty of evidence), participants’ mean satisfaction scores (MD -0.61, 95% CI -0.29,-0.04; I2=92%;very low certainty of evidence), participants’ tolerance scores (RR 0.83, 95% CI 0.71,0.97; I2=0%;low certainty of evidence), and endoscopist’s satisfaction scores (MD -0.33, 95% CI -0.45,-0.21;I2=94%;very low certainty of evidence).

Conclusions

Lidocaine spray may be better for ease of instrumentation during EGD. However, evidence is still determined due to the quality of trials.