Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Dig Endosc. 2013 Jan;25(1):20-4. doi: 10.1111/j.1443-1661.2012.01332.x. Epub 2012 Jun 3.
Transnasal esophagogastroduodenoscopy (EGD) has become widely accepted in Japan. Better performance and compliance for the procedure are expected with appropriate nasal anesthesia.We aimed to elucidate the effectiveness, the safety and the compliance of nasal anesthesia for transnasal EGD.
Subjects were 372 asymptomatic patients examined by transnasal EGD for gastric cancer screening. They were pretreated with topical anesthesia either with a nasal spray method (Spr group, n = 127), cotton-tipped applicator method (Cot group, n = 115), or both (Com group, n = 130). Lidocaine (4%) was applied with atomizer in the Spr method, whereas a cotton-tipped applicator soaked in 4% lidocaine was placed in the nasal cavity for 5 min in the Cot method. After transnasal EGD, each subject rated procedure-related discomfort according to visual analogue scales. In subjects who had prior experience of transoral EGD, tolerance against EGD was compared between transnasal and transoral routes.
There were no severe adverse events related to topical anesthesia.Transnasal EGD was completed in 94.9% of the patients.Age, gender or insertion failure rate were not different among Spr, Cot and Com groups. Pain scores for anesthesia and examination were significantly lower in the Spr group, whereas the pain score for insertion was not different among the three groups.The rate of patients who deemed transnasal EGD to be more tolerable than transoral EGD was highest in the Spr group.
Topical nasal spray seems to be appropriate for topical anesthesia in transnasal EGD.
经鼻胃镜检查（EGD）在日本已被广泛接受。人们期望通过适当的鼻腔麻醉来提高该操作的性能和顺应性。我们旨在阐明经鼻 EGD 中鼻腔麻醉的有效性、安全性和顺应性。
本研究纳入了 372 例接受经鼻 EGD 进行胃癌筛查的无症状患者。他们分别接受了鼻腔喷雾法（Spr 组，n = 127）、棉拭子法（Cot 组，n = 115）或联合应用（Com 组，n = 130）进行局部麻醉预处理。Spr 法中，使用喷雾器将 4%利多卡因喷入鼻腔；而 Cot 法则是将蘸有 4%利多卡因的棉拭子置于鼻腔内 5 分钟。经鼻 EGD 后，每位患者均根据视觉模拟评分法（VAS）对与操作相关的不适进行评分。对于有经口 EGD 经验的患者，比较了经鼻和经口途径的 EGD 耐受性。
没有与局部麻醉相关的严重不良事件。94.9%的患者完成了经鼻 EGD。Spr、Cot 和 Com 三组之间的年龄、性别或插入失败率均无差异。Spr 组的麻醉和检查疼痛评分明显低于其他两组，而三组的插入疼痛评分无差异。认为经鼻 EGD 比经口 EGD 更耐受的患者比例在 Spr 组最高。
鼻腔喷雾似乎适合用于经鼻 EGD 的局部麻醉。
