Role of Nebulization for Gastrointestinal Endoscopy
Keywords:
anti-foaming agents, gastrointestinal endoscopy, mucolytic agents, nebulization, sedative agents, topical anesthesiaAbstract
Nebulization has emerged as a useful adjunct in gastrointestinal endoscopy (GIE) procedure, improving patient comfort and endoscopic visibility while maintaining a favorable safety profile. Its applications mainly include topical anesthesia and sedation for oropharyngeal and upper GIE procedures, as well as the administration of mucolytic and anti-foaming agents to enhance mucosal visualization. This review summarizes the current role of nebulization in GIE, including topical anesthesia, mucolytics, anti-foaming, and sedative agents. We also describe its clinical use, advantages, disadvantages, limitations, and cost-effectiveness of nebulization for GIE procedures.
References
Amornyotin S, Pranootnarabhal T, Chalayonnavin W, Kongphlay S. Anesthesia for gastrointestinal endoscopy from 2005-2006 in Siriraj Hospital: a prospective study. Thai J Anesthesiol. 2007;33:93-101.
Amornyotin S, Prakanrattana U, Chalayonnavin W, Kongphlay S. Anesthesia for gastrointestinal endoscopy in extremely elderly patients. Thai J Anesthesiol. 2009;35:91-9.
Chandee T, Orrapin S, Mahawongkajit P, et al. Lidocaine spray versus other forms for local anesthesia in upper gastrointestinal endoscopy: a systematic review and meta-analysis. Siriraj Med J. 2025;77:725-37.
Amornyotin S, Srikureja W, Chalayonnavin W, Kongphlay S, Chatchawankitkul S. Topical viscous lidocaine solution versus lidocaine spray for pharyngeal anesthesia in unsedated esophagogastroduodenoscopy. Endoscopy. 2009;41:581-6.
Mallik D, Singh A, Narayan J. Study on nebulized or sprayed lidocaine as anesthesia for esophago-gastro duodenoscopy (EGD). Int J Appl Res. 2019;5:125-8.
Noitasaeng P, Vichitvejpaisal P, Kaosombatwattana U, Jaiyen T, Siriwongsa S. Comparison of spraying and nebulized lidocaine in patients undergoing esophago-gastro-duodenoscopy: a randomized trial. J Med Assoc Thai. 2016;99:462-8.
Negi DG, Sharma A, Norbu S, Pathnia J, Sharma B. Preprocedural nebulisation with 4% lignocaine and ketofol sedation during endoscopic retrograde cholangiopancreatography procedure for abolition of gag reflex: a randomised double-blinded study. J Clin Diag Res. 2023;17:UC05-9.
Krishnamurthy V, Joseph A, Venkataraman S, Kurian G. Simethicone and N-acetyl cysteine combination as premedication before esophagogastroduodenoscopy: double-blind randomized controlled trial. Endosc Int Open. 2022;10:E585-92.
Chang WK, Yeh MK, Hsu HC, Chen HW, Hu MK. Efficacy of simethicone and N acetylcysteine as premedication in improving visibility during upper endoscopy. J Gastroenterol Hepatol. 2014;29:769-74.
Kim GH, Cho YK, Cha JM, Lee SY, Chung IK. Effect of pronase as mucolytic agent on imaging quality of magnifying endoscopy. World J Gastroenterol. 2015;21:2483-9.
Lin J, Wu C, Zhao D, Du X, Zhang W, Fang J. The sedative effects of inhaled nebulized dexmedetomidine on children: a systematic review and meta-analysis. Front Pediatr. 2022;10:865107.
Sriramka B, Awal S, Mallik D, Narayan J. Nebulised dexmedetomidine for patient’s comfort and satisfaction during diagnostic upper gastrointestinal endoscopy: a double‑blind randomised controlled study. Indian J Anaesth. 2023;67:825‑7
Allah MSAA, Abaza KAGD, Mahmoud HAB, Wahdan RA, Farrag NM. Current evidence on nebulized sedation strategies for upper GI endoscopy: focus on dexmedetomidine and ketamine. J Comput Anal Appl. 2024;33:2303-17.
Allah MSAA, Abaza KAGD, Mahmoud HAB, Wahdan RA, Farrag NM. Nebulization of either dexmedetomidine or ketamine as adjuvant to propofol sedation in upper GI endoscopy: a randomised controlled double blind study. Zagazig Univ Med J. 2025;31:4689-700.
Turunc E, Ustun YB, Bilgin S, Kaya C, Koksal E, Dost B. Effect of nebulized dexmedetomidine on gag reflex suppression and sedation quality in pediatric patients undergoing gastrointestinal endoscopy: a randomized controlled trial. BMC Anesthesiol. 2025;25:227.
Gaballa NK, Elhamid TA, Mabdalla H. Effect of nebulized dexmedetomidine on pediatric hepatic patients undergoing upper endoscopy; a randomized controlled trial. Curr Res J Hepato Gastroenterol. 2021;5:1-4.
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