Background and objective Upper gastrointestinal tract endoscopy (UGIE) is widely performed under propofol sedation, which is considered as a safe sedation agent and alleviates the sympathetic response to the procedure. However, retching and gag reflex still disturb ∼29% of those patients despite being under propofol sedation. Patients and methods A total of 120 adult patients scheduled for elective UGIE were randomly allocated into three equal groups (40 patients each): group C was given propofol 50 mg, group D was given propofol 50 mg+dexmedetomidine 0.5 μg/kg, and group L was given propofol 50 mg+15 g palatable lidocaine gel. The outcome measures included incidence of gag reflex, propofol consumption, recovery time, intraoperative hemodynamics, and patients’ and endoscopist’s satisfaction. Results The incidence of gag reflex was statistically significantly reduced in groups L and D compared with group C; however, the reduction was more in group L but with no significant difference when compared with group D group. Propofol consumption was statistically significantly lower in groups L and D compared with group C, as well as recovery time was significantly shorter in groups L and D compared with group C. Group L showed the least hemodynamic changes among the three groups, and the endoscopist as well as the patients were statistically significant more satisfied in both groups L and D when compared with group C. Conclusion Using palatable lidocaine gel in addition to propofol in patients undergoing UGIE was safe and effectively reduced the incidence of gag reflex and the dose of intravenous propofol with its subsequent complications, shortening recovery time and improving patient and endoscopist satisfaction