Paratracheal pressure reduces the incidence of moderate-to-severe coughing during endoscopic esophageal iodine staining: a prospective, randomized controlled trial

Abstract Background Endoscopic iodine staining is a crucial technique for diagnosing esophageal cancer and precursor lesions. However, it carries the risk of adverse events such as pharyngeal discomfort, coughing, and aspiration. The study aimed to investigate the effectiveness of anesthesiologist-assisted paratracheal pressure in reducing the incidence of coughing during this procedure. Methods Patients were randomly allocated to two groups. In the treatment group (paratracheal pressure), when the endoscope reached approximately 20 cm from the incisors, the anesthesiologist performed paratracheal pressure just before iodine spraying and maintained it for 5 s after spraying ceased. The endoscopist then observed the staining pattern. The pressure was reapplied during saline rinsing and released 5 s after rinsing completion. The control group (no paratracheal pressure) underwent the standard procedure without paratracheal pressure. The primary outcome was the incidence of moderate-to-severe coughing during the procedure. Results The incidence of moderate-to-severe cough was significantly lower in the treatment group than in the control group (7.50% (3/40) vs. 32.50% (13/40); risk difference = − 25.00%, 95% confidence interval (CI): − 40.48% to − 9.52%). This association remained statistically significant after multivariable adjustment (adjusted odds ratio = 0.11, 95%CI: 0.02 to 0.55; P = 0.007). At 2 min post-compression, the treatment group also exhibited significantly lower mean arterial pressure (MAP: 88.05 ± 5.82 vs. 93.83 ± 5.07 mmHg) and heart rate (HR: 68.70 ± 7.91 vs. 73.03 ± 10.39 bpm). These differences were further confirmed by analysis of covariance. Conclusions Anesthesiologist-assisted paratracheal pressure effectively reduces the incidence of moderate-to-severe coughing and pharyngeal discomfort during endoscopic iodine staining, while also promoting greater hemodynamic stability. Trial registration ChiCTR2400088832.