Continuous liquid‐suction catheter attachment for endoscope reduces volume of liquid reflux to the mouth in esophageal endoscopic submucosal dissection

Abstract

Background and Aim Pooling of liquid in the esophageal lumen can worsen the field of vision and cause liquid reflux to the mouth, which leads to aspiration pneumonia, in esophageal endoscopic submucosal dissection (ESD). We developed a continuous liquid‐suction catheter attachment for the endoscope (CLCA) that has multiple tiny holes and can suction the liquid without causing mucosal injury. Thus, we aim to show the efficacy of CLCA in esophageal ESD. Methods This was a single‐blinded, randomized controlled trial involving patients with superficial esophageal cancer. The enrolled patients were randomly assigned to the conventional ESD (C‐ESD) or ESD with CLCA (CLCA‐ESD) groups. Primary endpoint was volume of liquid reflux to the mouth during the ESD procedure. Secondary endpoints were incidence of aspiration pneumonia and procedure time. Results Fifty patients were enrolled in this trial. Volume of liquid reflux to the mouth was significantly lower in the CLCA‐ESD group than in the C‐ESD group (mean: 10 vs 73 mL, P = 0.010). Furthermore, the incidence of aspiration pneumonia on computed tomography (CT) scan between the two groups was also significantly different (4.0% vs 32.0%, P = 0.023), although no significant difference was observed through chest radiography. In addition, procedure time tended to be shorter in the CLCA‐ESD group (P = 0.054). Conclusion This study first showed that use of CLCA in esophageal ESD reduced the volume of liquid reflux to the mouth and contributed to decreased incidence of aspiration pneumonia on CT scan (UMIN000018167).

Recent approach for preventing complications in upper gastrointestinal endoscopic submucosal dissection

“…Aspiration pneumonia occurs in 1.6%–4.0% of esophageal ESD. 3 , 38 Although clinical symptoms are mild in most patients, symptoms can become serious in elderly patients. The cause of this complication is considered to be liquid reflux from the esophagus to the mouth and saliva retention in the oral cavity.…”

“…The cause of this complication is considered to be liquid reflux from the esophagus to the mouth and saliva retention in the oral cavity. 38 , 39 To prevent pneumonia, some methods have been developed. One is continuous saliva suction using a tube 39 (Figure 1a,b ) or mouthpiece.…”

“… 40 The other is a continuously liquid‐sucking catheter attachment for the endoscope to reduce the volume of liquid reflux to the mouth (Figure 1c,d ). 38 A randomized controlled trial revealed that the use of this device in esophageal ESD reduced the volume of liquid reflux to the mouth and contributed to the decreased incidence of aspiration pneumonia on computed tomography scan. 38 Since the age peak has risen in esophageal cancer in Japan, 41 the issue of aspiration pneumonia in esophageal ESD will be more important in the near future.…”

Management following endoscopic resection in elderly patients with early‐stage upper gastrointestinal neoplasia

“…[10][11][12][13][14][15] Endoscopic mucosal resection (EMR) is accepted as a minimally invasive treatment method for early-stage upper GI neoplasia with almost no risk for lymph node metastasis (LNM) and endoscopic submucosal dissection (ESD) has replaced EMR in East Asia. 7,[16][17][18][19][20][21] Recent advances in devices or sodium alginate submucosal injection solution [22][23][24] may contribute to the increased use of ESD worldwide.…”

Continuous saliva suction tube to prevent aspiration pneumonia during upper GI endoscopy

“…Several reports have described use of the device for continuous saliva suction. 1,4 In one report, the device was attached to an endoscope to prevent aspiration during esophageal ESD, 1 but special settings were required, and continuous suction under all situations was difficult because the degree of suction was affected by the operation of the endoscope. Furthermore, although this method was useful for the suctioning of liquid pooling in the esophageal lumen to prevent backflow into the oral cavity, suctioning of saliva in the oral cavity itself was difficult.…”