BACKGROUND AND STUDY AIMS The use of sedation in upper gastrointestinal endoscopy is widespread, mainly because of the belief that patients are likely to tolerate the procedure better. The aim of the present study was to assess patients' response to the policy of actively persuading them to accept a throat spray for upper gastrointestinal endoscopy. PATIENTS AND METHODS Three hundred patients who had recently undergone endoscopy were sent a questionnaire; 244 of them responded (81%). Data on age, sex, procedure tolerance, anxiety levels, and future choice of sedation or throat spray for repeat procedures were sought. The results were analysed using the chi-squared test. RESULTS One hundred and ninety-two (79%) chose, or were persuaded to have, throat spray, and only nine (5%) had to be transferred to sedation. Thirty-two percent of patients who had throat spray tolerated endoscopy well, compared to 70% of those who chose sedation. One hundred and nineteen throat spray patients (62%) showed a low level of reluctance to undergo repeat endoscopy, compared to 37 (71%) sedated patients (not significant). One hundred and forty-four throat spray patients (76%) expressed satisfaction with the throat spray, but if given a choice, only 124 (66%) would choose throat spray again. Male patients, those with lower anxiety levels, and those over 50 years old, tolerated endoscopy with throat spray better, showed less reluctance to undergo repeat endoscopy, and were more likely to choose throat spray again. Those who had any previous experience of endoscopy under sedation were less likely to choose throat spray again. CONCLUSION The present study shows that the use of throat spray for diagnostic endoscopy is quite acceptable to patients. For safety reasons, we should be encouraging greater use of throat spray in routine diagnostic upper gastrointestinal endoscopy.