Lidocaine Spray versus Other Forms for Local Anesthesia in Upper Gastrointestinal Endoscopy: A Systematic Review and Meta-analysis

Objective: To evaluate the effectiveness of various lidocaine forms compared to the traditional spray during esophagogastroduodenoscopy (EGD). Materials and Methods: We searched PubMed, Scopus, EMBASE, the Cochrane Central Register of Controlled Trials, CENTRAL, Web of Science Core Collection, World Health Organization, International Clinical Trials Registry Platform, and ClinicalTrials.gov databases in December 2022. Selection criteria were randomized controlled trials comparing lidocaine spray with other forms of pharyngeal anesthesia. Outcomes of interest included ease of instrumentation, participants’ satisfaction scores, tolerance scores, pain, endoscopist’s satisfaction scores, and procedural time. Results: We included 13 trials with 3,711 participants. The quality of trials was poor. Lidocaine spray provided better ease of instrumentation (risk ratio (RR) 1.19, 95% confidence intervals (CI)1.06,1.34; I2 = 66%; very low certainty of evidence), decreased participants’ pain (mean difference (MD) 0.38, 95% CI 0.25,0.5; I2 = 92%; very low certainty of evidence), and shorter procedural time (MD 0.22, 95% CI 0.10,0.35; I2 = 13%; low certainty of evidence). However, spray had lower participants’ highest satisfaction scores (RR 0.83, 95% CI 0.76,0.92; I2 = 62%; very low certainty of evidence), participants’ mean satisfaction scores (MD -0.61, 95% CI -0.29,-0.04; I2 = 92%; very low certainty of evidence), participants’ tolerance scores (RR 0.83, 95% CI 0.71,0.97; I2 = 0%; low certainty of evidence), and endoscopist’s satisfaction scores (MD -0.33, 95% CI -0.45,-0.21; I2 = 94%; very low certainty of evidence). Conclusion: Evidence suggests that lidocaine spray may improve the ease of EGD instrumentation, although limitations in trial quality warrant cautious interpretation.