Comparative Effects of Flurbiprofen—Lidocaine Spray Versus Lidocaine Spray Alone as Topical Pharyngeal Anesthesia Before Unsedated Upper Gastrointestinal Endoscopy

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The study is interesting overall but the topic itself needs further exploration. The study is scientifically sound and especially so since randomized and double blind. A higher sample size and involving multiple centers would yield higher value as well. Perhaps a follow up study can be performed using a higher sample size. Overall it is worth recognition and has clinical impact as well. The study design is clear and the topic is portrayed clearly. The discussion is justified based on the results and supported by relevant references. The limitations are mentioned in depth as well.

Author Response

We appreciate the prompt response to our submission and thank the reviewer for the insightful comments, which we believe offer valuable suggestions for future studies.

Reviewer 2 Report

Comments and Suggestions for Authors

This is a well-designed, double-blind RCT addressing a clinically relevant question about optimizing topical anesthesia for unsedated EGD. The methodology is generally sound, and the topic aligns with current trends favoring minimally sedated procedures. However, key limitations affect the interpretation of results, primarily the small sample size and baseline imbalance between groups.

1.In Abstract:

Keywords: Correct "Satifaction" to "Satisfaction". Consider adding "randomized controlled trial".

Conclusion: "Flurbiprogen" is a typo; correct to "Flurbiprofen".

2.In Methods:

The authors should specify the total dose/concentration of Lidocaine spray administered (e.g., X mg per puff, total X mg). This is crucial for reproducibility and comparison.

Please clarify the timing: "two applications of Lidocaine spray (5 puffs each for each application) were applied 5 minutes before EGD" - Was this 5 puffs total (unlikely) or 5 puffs per application x 2 applications = 10 puffs? Be explicit.

Please state the formulation/dose per puff of the Strepsils Intensive® spray (8.75 mg Flurbiprofen per puff? 2 puffs = 17.5 mg total?).

The anxiety score is described as 0-5 in the Methods text ("0 to 5 numerical rating scale (0, calm to 5, anxious)") but Table 1 shows a range of 0-4. Clarify the scale used (0-4 or 0-5?).

3.In Results:

Table 1: "Procedure duration" is listed as "5:23 min" and "5:22 min". Report this consistently, preferably in minutes (e.g., 5.23 min, 5.22 min) or state it's min:sec. The p-value calculation (0.962) suggests seconds were considered.

4.In Discussion:

The comparison to Mahawongkajit et al. (ice popsicle) is interesting but highlights that other methods (like ice popsicles) might be superior to sprays, which is a different question than adding Flurbiprofen to Lidocaine spray.

The discussion about ultrathin endoscopes (Page 7) is somewhat tangential, as a standard endoscope was used in this study. While relevant to tolerance generally, it doesn't directly relate to the comparison of topical anesthetics. Consider shortening or focusing more on the topical anesthesia aspect.

 

Author Response

We thank you for the rapid response to our submission and also thank the reviewer for his/her insightful comments that certainly helped us improve our manuscript.  We have now revised the manuscript accordingly.

1.In Abstract:

Keywords: Correct "Satifaction" to "Satisfaction". Consider adding "randomized controlled trial".

Conclusion: "Flurbiprogen" is a typo; correct to "Flurbiprofen".

We appreciate the feedback and we apologize for the errors. We have redone a thorough spelling check on the manuscript.

 

2.In Methods:

The authors should specify the total dose/concentration of Lidocaine spray administered (e.g., X mg per puff, total X mg). This is crucial for reproducibility and comparison.

Please clarify the timing: "two applications of Lidocaine spray (5 puffs each for each application) were applied 5 minutes before EGD" - Was this 5 puffs total (unlikely) or 5 puffs per application x 2 applications = 10 puffs? Be explicit.

Please state the formulation/dose per puff of the Strepsils Intensive® spray (8.75 mg Flurbiprofen per puff? 2 puffs = 17.5 mg total?).

We thank the reviewer A for the suggestions, the data has now been changed so that it can be more easily reproduced and compared.

The anxiety score is described as 0-5 in the Methods text ("0 to 5 numerical rating scale (0, calm to 5, anxious)") but Table 1 shows a range of 0-4. Clarify the scale used (0-4 or 0-5?).

We thank Reviewer A for the observation, however no patient from our study has picked 5 as a score, even though the scale is indeed ranging from 0 to 5.

 

3.In Results:

Table 1: "Procedure duration" is listed as "5:23 min" and "5:22 min". Report this consistently, preferably in minutes (e.g., 5.23 min, 5.22 min) or state it's min:sec. The p-value calculation (0.962) suggests seconds were considered.

We thank the reviewer for the suggestion and we have modified the according to your recommendations, stating min:sec. p-value indeed was calculated by transforming all data in seconds.

 

4.In Discussion:

The comparison to Mahawongkajit et al. (ice popsicle) is interesting but highlights that other methods (like ice popsicles) might be superior to sprays, which is a different question than adding Flurbiprofen to Lidocaine spray.

The discussion about ultrathin endoscopes (Page 7) is somewhat tangential, as a standard endoscope was used in this study. While relevant to tolerance generally, it doesn't directly relate to the comparison of topical anesthetics. Consider shortening or focusing more on the topical anesthesia aspect.

We thank the reviewer for the suggestion. In our manuscript, in the discussion part we presented other studies that tackle different options for local analgesia and the approach with ultrathin endoscopes as a possibility alongside the disadvantages of this procedure.

 

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

the manuscript can be accepted