Unsedated Esophagogastroduodenoscopy in Cirrhotic Patients: An Impact of Topical Pharyngeal Anesthesia

Esophagogastroduodenoscopy (EGD) is an endoscopic procedure which is commonly used for diagnostic and therapeutic purposes. The proportion of patients undergoing diagnostic EGD without sedation has been increasing over the past decade. In addition, EGD has several applications specific to the patients with chronic liver disease [1]. Unsedated esophagogastroduodenoscopy (UEGD) is generally safe and can be well tolerated [2]. In Thailand, most of diagnostic and screening EGDs are performed without sedation. Topical pharyngeal anesthesia is often used as premedication for EGD procedure [3,4]. In a meta-analysis, topical pharyngeal anesthesia before EGD with sedation is shown to increase the ease of endoscopy and the patient tolerance [5]. Topical pharyngeal anesthesia is also often used in UEGD procedure and is thought to improve the patient tolerance [2,6]. However, the effectiveness of topical pharyngeal anesthesia for UEGD procedure in cirrhotic patients has been limited reports in the medical literature.