Proposed Topic (Most preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Sit GYC(1), Wong KFK(1), Kwan MW(1), Leung CF(1), Chan TH(1), Lam YK(1), Wong HYS(1), Wu IHC(1), Wu Z(1), Liu KYE(1), Chan HLC(2), Wong, MF(2), Lam SM(2), Lo YY(2), Yan KM(2), Tam SK(2), Yau TW(2), Lo SW(2), Chan KY(2), Lau YW(2), Hui SY(2), Cheng KK(2), Wong KM(2), Cheung PS(2)
Affiliation :
(1)Department of Surgery, NTWC, Hospital Authority, Hong Kong, (2)Combined Endoscopy Unit, Tin Shui Wai Hospital, Hospital Authority, Hong Kong
Introduction :
Local pharyngeal anaesthesia (LPA) is routinely used for esophagogastroduodenoscopy (EGD), and its use has been studied.
Objectives :
We aim to investigate different regimens of LPA in minimizing patient throat discomfort during EGD.
Methodology :
This is a retrospective study involving patients with elective EGDs done from October, 2022 to June, 2023, in a regional hospital in Hong Kong. Lignocaine was used as LPA. The outcome measured was the immediate post-procedural throat discomfort, as a score of 1-5, with 4 and 5 regarded as significant discomfort. Patients with communication difficulties, previous gastrectomy or esophagectomy, aborted or refused EGDs, or allergies to lignocaine were excluded. The number of lignocaine spray puffs and the duration of which the patients were asked to swallow (i.e. sprayed duration) were categorized into four groups – group 1 patients received variable spray puffs and sprayed durations, group 2 received 10 puffs and variable sprayed durations, group 3 received 10 puffs and 1-minute sprayed durations. Patients in group 4 were asked to swallow immediately after 5 puffs were given, then received 5 puffs more and asked to swallow after positioning, and lignocaine jelly coated endoscopes were used. Before the examinations, patients’ anxiety levels were scored on a scale of 1-5, with 4 and 5 regarded as significant anxiety. Conventional 9.8 mm and 9.9 mm diameter endoscopes, and 5.4 mm nasoscopes were used. Subgroup analyses were done based on discomfort scores. A significant difference was considered when p-value < 0.05.
Result & Outcome :
A total of 1,016 patients were included after exclusion - 9.5% group 1, 23.1% group 2, 22.4% group 3 and 45% group 4. 63.3% patients were female. Patients received 10, 8, and 6 puffs in 90.6%, 6.0% and 3.4% respectively. Mean sprayed duration was 39.4 seconds (s.d. 18.4). Mean age was 58 years (s.d. 13.5). 59.5% patients had no prior EGDs done. 9.8mm and 9.9mm diameter endoscopes were used in 69.4% and 30.6% cases respectively. 5.4mm nasoscopes were used in 20 cases (2%). 14.1% patients were significantly anxious before examination. The indications for EDGs were epigastric pain (74.3%), anaemia (3.5%), follow-up for ulcer (6.5%), screening for malignancy (3.4%), acid reflux (4.2%) and others (8.0%). The diagnosis of gastritis (56.2%), normal examination (26.0%), peptic ulcer disease (6.4%), gastric polyp (6.2%), and other (10.9%) were made. 93.9% EGDs included biopsy, 5.3% polypectomy, 0.8% without biopsy and 0.1% with duodenal clipping. Mean endoscope duration was 210.3 seconds (s.d. 107.9). 27.1% patients experienced significant discomfort.
Subgroup analyses showed patients with less number of lignocaine spray puffs received, as well as older, male, patients without significant anxiety and those with diagnoses of gastritis were associated with less significant discomfort from EGDs. No difference was observed with different lignocaine sprayed durations. Moreover, patient’s older age (OR 0.98, 95% CI 0.97 – 0.99), male sex (OR 0.01, 95% CI 1.10 – 1.99), absence of significant anxiety (OR 2.151, 95% CI 1.48 – 3.13) and a diagnosis of gastritis (OR 0.75, 95% CI 0.57-0.99) were independent predictors for absent of significant discomfort from EGD.
Conclusions
In our review, less lignocaine spray puffs used resulted in less significant discomfort from EGD. No difference was observed regarding sprayed duration.
