# Paratracheal pressure reduces the incidence of moderate-to-severe coughing during endoscopic esophageal iodine staining: a prospective, randomized controlled trial

## TL;DR

Applying pressure near the trachea during an endoscopic procedure significantly reduces coughing and discomfort, improving patient safety.

## Contribution

This study demonstrates that anesthesiologist-assisted paratracheal pressure reduces moderate-to-severe coughing during endoscopic iodine staining.

## Key findings

- Paratracheal pressure reduced moderate-to-severe cough incidence from 32.5% to 7.5%.
- The treatment group showed significantly lower mean arterial pressure and heart rate post-procedure.

## Abstract

Endoscopic iodine staining is a crucial technique for diagnosing esophageal cancer and precursor lesions. However, it carries the risk of adverse events such as pharyngeal discomfort, coughing, and aspiration. The study aimed to investigate the effectiveness of anesthesiologist-assisted paratracheal pressure in reducing the incidence of coughing during this procedure.

Patients were randomly allocated to two groups. In the treatment group (paratracheal pressure), when the endoscope reached approximately 20 cm from the incisors, the anesthesiologist performed paratracheal pressure just before iodine spraying and maintained it for 5 s after spraying ceased. The endoscopist then observed the staining pattern. The pressure was reapplied during saline rinsing and released 5 s after rinsing completion. The control group (no paratracheal pressure) underwent the standard procedure without paratracheal pressure. The primary outcome was the incidence of moderate-to-severe coughing during the procedure.

The incidence of moderate-to-severe cough was significantly lower in the treatment group than in the control group (7.50% (3/40) vs. 32.50% (13/40); risk difference = − 25.00%, 95% confidence interval (CI): − 40.48% to − 9.52%). This association remained statistically significant after multivariable adjustment (adjusted odds ratio = 0.11, 95%CI: 0.02 to 0.55; P = 0.007). At 2 min post-compression, the treatment group also exhibited significantly lower mean arterial pressure (MAP: 88.05 ± 5.82 vs. 93.83 ± 5.07 mmHg) and heart rate (HR: 68.70 ± 7.91 vs. 73.03 ± 10.39 bpm). These differences were further confirmed by analysis of covariance.

Anesthesiologist-assisted paratracheal pressure effectively reduces the incidence of moderate-to-severe coughing and pharyngeal discomfort during endoscopic iodine staining, while also promoting greater hemodynamic stability.

ChiCTR2400088832.

The online version contains supplementary material available at 10.1186/s12871-026-03644-y.