Lidocaine Gel or Spray During Upper Gastrointestinal Endoscopy: Efficacy and Safety Randomized Controlled Evaluation of Topical Pharyngeal Anesthesia: doi: 10.7417/CT.2026.1973

Background: Upper gastrointestinal endoscopy (UGIE) is a widely used procedure for the diagnosis and treatment of upper gastrointestinal diseases. The use of lidocaine as a topical pharyngeal anesthetic has been shown to facilitate endoscopy intubation and reduce pharyngeal mucosa injury. Lidocaine gel and spray are two common forms of topical pharyngeal anesthesia used to reduce discomfort and pain during these procedures. Methods: In This prospective, randomized, single-blinded clinical trial, 180 patients eligible for UGIE were randomly allocated into 2 groups. The first Group S (Lidocaine Spray) received 6 puffs of 10% lidocaine spray each puff delivering 10mg of lidocaine, sprayed to the pharynx distributed as 2 puffs in left, right and middle portion after tongue depression in 2 consecutive 30-second intervals. After each spray, patients were asked to swallow to maximize the anesthetic effect on the hypopharynx. The second Group G (Lidocaine Gel) received 10g of 2% lidocaine gel (gently applied 3-5 minutes before the endoscopy at three consecutive 30-second intervals on the palate and peritonsillar areas. Patients were informed to spread the gel within their mouth by the tongue and then swallow it to cover the oropharynx and esophagus. Outcome parameters included incidence of gag reflex as a primary outcome with the ease of esophageal entrance during endoscopy were compared. onset of numbness, Total propofol consumption, recovery time, Endoscopist and Patient Satisfaction and complications as a secondary outcome during UGIE. Results: Comparison between the groups studied regarding the outcome parameters. The Lidocaine gel groups achieved better performance and better scores in reducing gag reflex (6.67%) compared to (21.11%) Spray group, and ease of 1st attempt esophageal intubation is statistically significant better (96.67%) compared to (85.56%) in spray group as well as reducing total patient number of propofol needs 8/90 (8.89%) compared to 23/90 (25.56%) in Spray group as well as increase patient and endoscopist satisfaction. Conclusion: lidocaine Gel is considered safe, suitable and effective option and exhibiting better performance in reducing the incidence of gag reflex, with the ease of esophageal entrance shortening recovery time and improving patient and endoscopist satisfaction. Decrease total propofol consumption in patients undergoing UGIE compared to lidocaine spray.