EC Gastroenterology and Digestive System

Introduction: Gastroscopy is a means of exploring the upper digestive tract that is performed under sedation. It can also be performed without anesthesia and be a source of discomfort for the patient. We wonder if local anesthesia using lidocaine chlorhydrate gel associated with premedication with an anxiolytic is a credible alternative to upper GI endoscopy without sedation?

Methodology: Prospective analytical study from May 2022 to November 2022, conducted in the Hepato-Gastro-Enterology Department. It concerned all patients scheduled for gastroscopy. These patients were divided into two groups: The first group included patients who had received the gastroscopy without sedation and without premedication and the second group included patients who had received lidocaine chlorhydrate buccal gel at the time of the procedure with premedication by anxiolytic the day before the endoscopic examination.

Results: A total of 205 patients (110 in group 1 and 95 in group 2) were included in this study. The mean age was 45 years +/- 17.67 with a sex ratio of 0.95. Eighty-three patients (75.4%) in group 1 were anxious at the time of the endoscopy, compared with 6 (6.3%) in group 2. The examination lasted less than five minutes in 50 patients (45.4%) in group 1 and more than five minutes in 82 patients (86.3%) in group 2. After the gastroscopy was performed, 59 patients (62.1%) in the second group had no incidents, whereas all patients in the first group reported at least one incident. Tolerance was excellent in 39 patients (41%) of the second group, whereas none of the patients in the first group had an excellent tolerance. The acceptability of performing the gastroscopy was good in both groups (97.2% in group 1 and 93.4% in group 2). However, after the gastroscopy was performed, the acceptability dropped to 54.5% in the patients in the first group and only 45.4% of these patients recommended the performance of the gastroscopy under the same conditions to their next doctor. Whereas 81% of the patients in the second group accepted to repeat the examination under similar conditions and recommended it to their relatives.

There was a statistically significant difference in anxiety (p < 0.001), duration of the examination (p < 0.001), tolerance (p < 0.001), and incident occurrence (p < 0.001) between the two groups. The acceptability of repeating the examination under similar conditions and recommending it to the next patient was also statically significant (p < 0.001).

Conclusion: This study showed that patients who were candidates for upper gastrointestinal fibroscopy premedicated with anxiolytics associated with the use of lidocaine chlorhydrate gel had a better tolerance, acceptability and duration of the examination.

Keywords: Tolerance; Acceptability; Gastroscopy; Premedication; Lidocaine Gel

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