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Anxious patients tolerate endoscopy poorly. It was proposed that such patients might derive most benefit from sedation, while most non-anxious patients would prefer endoscopy with lignocaine throat spray alone. In a prospective study, 200 outpatients underwent diagnostic endoscopy after receiving one of two detailed information sheets which offered them either the choice between spray or sedation (n = 100) or the same choice but encouraged those who were anxious about endoscopy to choose sedation (n = 100). When given an informed choice, most non-anxious patients prefer not to be sedated most non-anxious patients prefer not to be sedated during diagnostic endoscopy. If patients who are anxious about the procedure are advised to choose sedation, those who nevertheless opt for topical throat spray alone find the endoscopy just as comfortable. If the endoscopy were to be repeated, 73% of the spray group and 77% of the sedation group would make the same choice again. Of 33 patients who chose spray but had been given only sedation for a previous endoscopy, 26 (79%) would choose spray again for a future endoscopy. The choice of spray or sedation should reflect the patient's view as well as that of the endoscopist.