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– groups (250 patients/group). The endoscopists obtained 10 images of the oropharynx and hypopharynx. The primary outcome was the non-inferiority of the PA– 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–) groups were 84.0% and 72.0%, respectively. The PA– 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±2.37 vs. 0.68±1.78, p=0.004, 0–10 point visual analog scale). Suitable quality images of the posterior wall of the oropharynx, vocal fold, and pyriform sinus were inferior in the PA– group. Subgroup analysis showed a higher sedation level (Ramsay score ≥5) 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.

An observation of the therapeutic effects of the parallel use of acupuncture/moxibustion and medicine (mainly herbs) on 8 patients with chronic liver disorders at our clinic was done for a period of one year. The basic therapeutic points were: Right Chimen (LV), Right Puyung (ST), Chungwan (CV), Tsu sanli (LU), Sanyinchiao (SP), Taichong (LV), Chihyang (GV), Keshu (BL) and Pishu (BL); and other points were determined according to the subjective symptoms of each patient. Treatments were done 2 times a week as a basic rule. Significant improvements were observed in serum GOT, GPT and γ-GTP, and an increase was observed in serum protein. Also, a significant improvement was observed in the subjective symptoms of patients.
Judging from these results, it is suggested that the parallel use of acupuncture/moxibustion and medicine proves to be effective in the treatment of chronic liver disorders.