ABSTRACT
OBJECTIVE: We undertook this study to determine whether topical pharyngeal anesthesia with conscious sedation is superior to conscious sedation alone, with respect to procedure performance or tolerance in patients undergoing diagnostic upper gastrointestinal endoscopy. METHODS: Ninety-five patients undergoing diagnostic upper endoscopy with conscious sedation were randomized to receive either topical pharyngeal anesthesia with 2% tetracaine/14% benzocaine spray or no pharyngeal anesthesia. Conscious sedation was achieved in all patients using intravenous midazolam and meperidine. Patients were asked to rate their pretest anxiety, comfort during endoscopy, recollection of the procedure, and willingness to undergo subsequent examinations using a 100-mm visual analog scale. Additionally, they were asked to estimate procedure duration and rate their tolerance for topical pharyngeal anesthesia. All examinations were performed by two endoscopists who were blinded to whether or not patients had received pharyngeal anesthesia. Endoscopists were asked to determine whether they believed that patients had received topical pharyngeal anesthesia and to estimate ease of esophageal intubation and procedure performance using a 100-mm visual analog scale. Procedure duration and doses of midazolam and meperidine were measured. RESULTS: The two groups did not differ with respect to age, gender, and previous endoscopic history. There were no significant differences between the two groups with respect to pretest anxiety, procedural comfort, and willingness to undergo subsequent examinations. Patients receiving topical pharyngeal anesthesia rated it as moderately unpleasant. Endoscopists were able to discriminate patients who received pharyngeal anesthesia from those who did not with a sensitivity of 0.73 and a specificity of 0.59. There were no significant differences between the two groups with respect to ease of intubation, procedure performance, procedure duration, and dosing of midazolam or meperidine. CONCLUSIONS: In patients undergoing diagnostic upper endoscopy using intravenous midazolam and meperidine, the use of topical pharyngeal anesthesia does not improve patient tolerance or procedure performance. Elimination of this agent in the performance of diagnostic upper endoscopy will save time and money without adversely affecting patient care or outcomes.
Subject(s)
Anesthesia, Local , Conscious Sedation , Endoscopy, Gastrointestinal , Pharynx , Anesthetics, Local , Benzalkonium Compounds , Benzocaine , Cetrimonium Compounds , Drug Combinations , Female , Humans , Male , Middle Aged , Patient Satisfaction , Single-Blind Method , Tetracaine , para-AminobenzoatesSubject(s)
Endoscopy, Gastrointestinal/methods , Gastrointestinal Diseases/therapy , Triamcinolone Acetonide/administration & dosage , Adult , Aged , Combined Modality Therapy , Constriction, Pathologic/etiology , Constriction, Pathologic/therapy , Dilatation , Endoscopes, Gastrointestinal , Evaluation Studies as Topic , Female , Gastrointestinal Diseases/etiology , Humans , Injections, Intralesional , Male , Middle Aged , Time FactorsABSTRACT
This study prospectively evaluated a dedicated effort to intubate the terminal ileum in an unselected population of patients undergoing colonoscopy in conjunction with our training program. The influence of the visual appearance of the terminal ileal mucosa on patient management was assessed subjectively. The cecum was reached in 270/295 (91%) patients, with successful terminal ileal intubation being accomplished in 213/270 (79%) examinations. The time required to intubate the terminal ileum (x = 3.4 minutes; range, 30 seconds to 10 minutes) was not significantly different (p < 0.05) between the several levels of training in our fellowship program. The terminal ileum was considered to be visually abnormal in 4 cases, but only 1 of these was abnormal on histologic examination. In this unselected population, routine ileoscopy was unrewarding for finding an incidental positive diagnosis; however, brief attempts at terminal ileal intubation may be useful to improve or maintain endoscopic skills, especially in a training setting.
