Local Anaesthesia of the Pharynx for the Oesophago-gastroduodenoscopy (OGD); New (JASMEG) Technique with Better Patient Tolerance and Reduced Risk of Airborne Spread
Esther Killan, Suchika Garg, Marlon Amulong, Julian Gardiner and Jude A Oben*
ABSTRACT
Background: Oesophago-gastro-duodenoscopy (OGD-Gastroscopy) is a procedure routinely performed in secondary care. Lignocaine as a local anaesthetic is administered prior, to make patients more comfortable. During the Coronavirus disease-19 (COVID-19) epidemic, with the virus known to be predominantly spread via cough droplets, there was great concern in endoscopic units. About 1500 healthcare workers died in the United Kingdom due to COVID-19, some from endoscopic units. This study was commenced during the COVID-19.
Objective: The study focused on the administration of lignocaine as a local anaesthetic prior to OGD. The current modality is to administer lignocaine to the patients’ posterior pharynx with their mouth open: “mouth-open” technique. We proposed the 'JASMEG' technique, involving spraying the pharynx with the mouth closed around the spray nozzle. Our aim was to determine if the novel JASMEG technique of lignocaine administration, reduced incidence of cough, increased patient comfort and reduced patient anxiety. Design: As a service improvement audit design, there were 474 patients (male: female = 1.13) undergoing an OGD as part of routine care in a district general hospital in the United Kingdom. Of these, 222 had their OGD with their mouths open (122♂ and 100♀) and 252 patients with JASMEG, with their mouths closed (130♂ and 122♀). Results: Compared to the “mouth-open” group, the “JASMEG” group demonstrated a smaller increase in pulse rate (group difference = -3.97, p< 0.001), lower anxiety scores (group difference = -1.31, p < 0.001), higher comfort scores (group difference = 1.07, p< 0.001) and most importantly a lower incidence of cough (13 out of 252 vs 190 out of 222; p<0.001). Conclusion: We propose that colleagues should consider adopting the JASMEG technique during OGD. JASMEG potentially reduces infection spread, is more comfortable for patients and with reduced anxiety.
