{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T02:12:12Z","timestamp":1788487932508,"version":"build-2803163510"},"reference-count":28,"publisher":"The Korean Society of Gastrointestinal Endoscopy","issue":"5","license":[{"start":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T00:00:00Z","timestamp":1681257600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":["e-ce.org"],"crossmark-restriction":true},"short-container-title":["Clin Endosc"],"published-print":{"date-parts":[[2023,9,30]]},"abstract":"<jats:p>Background\/Aims: The necessity for pharyngeal anesthesia during upper gastrointestinal endoscopy is controversial. This study aimed to compare the observation ability with and without pharyngeal anesthesia under midazolam sedation.Methods: This prospective, single-blinded, randomized study included 500 patients who underwent transoral upper gastrointestinal endoscopy under intravenous midazolam sedation. Patients were randomly allocated to pharyngeal anesthesia: PA+ or PA\u2013 groups (250 patients\/group). The endoscopists obtained 10 images of the oropharynx and hypopharynx. The primary outcome was the non-inferiority of the PA\u2013 group in terms of the pharyngeal observation success rate.Results: The pharyngeal observation success rates in the pharyngeal anesthesia with and without (PA+ and PA\u2013) groups were 84.0% and 72.0%, respectively. The PA\u2013 group was inferior (p=0.707, non-inferiority) to the PA+ group in terms of observable parts (8.33 vs. 8.86, p=0.006), time (67.2 vs. 58.2 seconds, p=0.001), and pain (1.21\u00b12.37 vs. 0.68\u00b11.78, p=0.004, 0\u201310 point visual analog scale). Suitable quality images of the posterior wall of the oropharynx, vocal fold, and pyriform sinus were inferior in the PA\u2013 group. Subgroup analysis showed a higher sedation level (Ramsay score \u22655) with almost no differences in the pharyngeal observation success rate between the groups.Conclusions: Non-pharyngeal anesthesia showed no non-inferiority in pharyngeal observation ability. Pharyngeal anesthesia may improve pharyngeal observation ability in the hypopharynx and reduce pain. However, deeper anesthesia may reduce this difference.<\/jats:p>","DOI":"10.5946\/ce.2022.182","type":"journal-article","created":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T05:24:00Z","timestamp":1681277040000},"page":"594-603","update-policy":"https:\/\/doi.org\/10.5946\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Necessity of pharyngeal anesthesia during transoral gastrointestinal endoscopy: a randomized clinical 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