Acupuncture for relief of gagging in patients undergoing transoesophageal echocardiography—a randomised placebo-controlled trial

BACKGROUND: Gagging during transesophageal echocardiography (TEE) can make the procedure distressing and even impossible to perform. Acupuncture is suggested to relieve the gag reflex during peroral endoscopic procedures. The aim was to test whether acupuncture is better than placebo for reducing gagging in patients undergoing elective ambulatory TEE. METHODS: Sixty patients scheduled for ambulatory TEE were included according to eligibility criteria and received either fixed intradermal needles (N = 30) or placebo needles at acupuncture points CV24 and PC6 in a random order prior to TEE. Patients and practitioners, who performed TEE procedure and assessed the outcome measures were unaware of group (acupuncture or placebo) allocation. The primary outcome was the intensity of gagging, measured using verbal rating scale (VRS-11). Secondary outcomes included the use of rescue medication, the incidence of gagging, patients' satisfaction with relief of unwanted side effects during TEE procedure, success of patients' blinding, heart rate and oxygen saturation. RESULTS: Median (IQR) of patient's reported gagging intensity in the acupuncture group was 4 (2-8) vs. 7 (5-8) in the placebo group (P = 0.13), the gagging intensity reported by TEE-examiner was 2 (1-5) among the patients from the acupuncture group vs. 4 (2-9) in the placebo group (P = 0.06). Six patients from the acupuncture group vs. 14 from the placebo group required sedative rescue medication (P = 0.03). All other measured outcomes were comparable between the study groups. CONCLUSIONS: Acupuncture with indwelling fixed intradermal needles may reduce the need for sedative medication in patients scheduled for elective TEE. Larger trials with improved methodology are required to verify this finding. TRIAL REGISTRATION: NCT03821428; registration date: January 25, 2019.