Reply to “Evaluation of pharyngeal lidocaine anesthesia for esophagogastroduodenoscopy: Double‐blind randomized control trial” by Martín‐Marcos et al.

Abstract

We read with interest the recent article by Mart ın-Marcos et al. 1 evaluating the effectiveness of pharyngeal lidocaine anesthesia for esophagogastroduodenoscopy. However, there were two issues in that study that would have made the clinical significance of their findings questionable.First, topical lidocaine increased the proportion of procedures where endoscopists rated patient tolerance as good, but all procedures in the control group were successfully completed. Furthermore, the levels of tolerance and satisfaction reported by patients, and the duration of the procedure, were not statistically significant between the groups. The satisfaction of endoscopists obtained by an 11-point numeric rating scale was significantly higher in the lidocaine group, but the intergroup net difference in median satisfaction levels of endoscopists was only 1. Most important, an endoscopists' satisfaction of median 9 in the control group is quite acceptable in clinical practice. Thus, it is difficult for readers to determine whether this benefit of topical lidocaine to improve the procedure as rated by endoscopists should be considered clinically important.Second, patients' satisfaction is very important for determining the clinical availability of an intervention. 2 This study evaluated satisfaction of patients during the procedure, but this assessment is less accurate due to the effects of sedation. In fact, patients' satisfaction is not only dependent on the intraoperative experience, but also on the occurrence of postoperative adverse events. We noted that the control patients were more likely to experience intraoperative coughing, but those receiving lidocaine were more likely to cough during the recovery period. Due to the blocking of upper airway sensory receptors, topical lidocaine may often result in postoperative pharyngeal discomfort, including dryness and dysphagia, especially after a short procedure. 3 We believe that this study would have provided more useful data about the effectiveness of pharyngeal lidocaine anesthesia for esophagogastroduodenoscopy if the design had included a postoperative assessment of patients' satisfaction, as performed in previous studies. 4,5

Response to reply to “Evaluation of pharyngeal lidocaine anesthesia for esophagogastroduodenoscopy: Double‐blind randomized control trial” by Martín‐Marcos et al.

“…With respect to the second issue, we should clarify that the assessment of the satisfaction and tolerance of both the patient and the endoscopist was carried out after the endoscopic examination, in the recovery area. On the other hand, we agree with the explanation put forward by He et al 1 . for coughing during recovery of the lidocaine group.…”

“…We read with interest the letter by He et al 1 . regarding our study evaluating the effectiveness of pharyngeal lidocaine anesthesia for esophagogastroduodenoscopy 2 .…”

“…We read with interest the letter by He et al 1 regarding our study evaluating the effectiveness of pharyngeal lidocaine anesthesia for esophagogastroduodenoscopy. 2 The authors question the clinical significance of the findings with respect to two issues.…”