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

Muramoto, Takashi; Aoki, Ayumi; Suzuki, Yuichiro; Hishida, Maki; Ohata, Ken

doi:10.1016/j.vgie.2020.11.002

Cited by 3 publications

(6 citation statements)

References 5 publications

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“…Post-ESD pneumonia is believed to be affected by the patient's intraoperative lateral decubitus position and sedation, and a previous report linked it to esophagopharyngeal reflux. 8,35 HRM examination of patients with post-ESD pneumonia showed decreased pressure from the pharynx to the upper esophagus pre-ESD, suggesting that reflux was more likely to occur. Therefore, post-ESD pneumonia may have a different cause than regular aspiration pneumonia, and identifying a low UES-IRP as a risk factor for ESD pneumonia is reasonable.…”

Section: Discussionmentioning

confidence: 99%

Impact of low pharyngeal/esophageal pressure associated with sarcopenia on postendoscopic submucosal dissection pneumonia in patients with superficial esophageal cancer

Taniguchi,

Ono,

Haraguchi

et al. 2023

Digestive Endoscopy

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ObjectivesThe aging population, including patients with superficial esophageal cancer, encounters critical dysphagia‐ and postoperative pneumonia‐related issues. Although endoscopic submucosal dissection (ESD) provides advantages over other modalities, older patients are at higher risk of postoperative pneumonia. Furthermore, the etiologies of pneumonia are complex and include patient‐ (such as sarcopenia) and treatment‐ (including ESD) related factors. Therefore, this study evaluated swallowing function in patients with superficial esophageal cancer and identified post‐ESD pneumonia‐associated factors.MethodsComprehensive swallowing function and sarcopenia were evaluated in patients pre‐ESD and 2 months post‐ESD using high‐resolution manometry and several swallowing studies by multiple experts. The effects of mucosal resection and sarcopenia on swallowing function changes post‐ESD, the relationship between preoperative swallowing function and sarcopenia, and the factors influencing postoperative pneumonia were investigated.ResultsTwenty patients were included in the study. Patients with preoperative sarcopenia had significantly lower pharyngeal/upper esophageal sphincter and tongue pressures than those without sarcopenia. However, ESD did not worsen pharyngeal or upper esophageal pressure. Post‐ESD pneumonia incidence tended to be higher in patients with sarcopenia than in those without sarcopenia. The lower upper esophageal sphincter‐integrated relaxation pressure (UES‐IRP) was a significant factor in pneumonia development. Furthermore, the receiver operating characteristic curve for UES‐IRP in pneumonia yielded an area under the curve of 0.82.ConclusionsSarcopenia is associated with preoperative dysphagia, which increases post‐ESD pneumonia risk. Therefore, postoperative pneumonia incidence is expected to increase with an aging population, making preoperative sarcopenia and swallowing function evaluation crucial.

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Section: Discussionmentioning

confidence: 99%

Impact of low pharyngeal/esophageal pressure associated with sarcopenia on postendoscopic submucosal dissection pneumonia in patients with superficial esophageal cancer

Taniguchi,

Ono,

Haraguchi

et al. 2023

Digestive Endoscopy

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“…Intraoperative perforation 1.4%-4.6% 18 • Traction-assisted method to prevent "blind" dissection 20,21 Delayed perforation Rare (three cases; two of them required emergency surgery) 24,25 • Prevention of excessive energizing during ESD 23 Delayed bleeding 0.0%-6.7% 3,[27][28][29][30][31][32][33][34] • No established method Aspiration pneumonia 1.6%-4.0% 3,38 • Use of a tube or a mouthpiece for continuous saliva suction 39,40 • Use of a continuously liquid-sucking catheter attachment for the endoscope 38 Stricture 0.7% (<1/2 circumferential lesion) 27.6% (1/2-3/4 circumferential lesion) 94.1% (>3/4 circumferential lesion) 43 • Steroid injection [45][46][47][48][49][50][51] • Oral steroid intake [53][54][55][56]58 • Endoscopic balloon dilation 44 Meanwhile, patients undergoing esophageal and gastric ESD sometimes fall into a serious condition from complications. Furthermore, duodenal ESD is still not standardized and appears to have a higher frequency of complications than ESD in other organs.…”

Section: Frequency Preventative Methodsmentioning

confidence: 99%

“…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.…”

Section: Esophageal Esdmentioning

confidence: 99%

“… 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 ).…”

Section: Esophageal Esdmentioning

confidence: 99%

“…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 38,39 . To prevent pneumonia, some methods have been developed.…”

Section: Esophageal Esdmentioning

confidence: 99%

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Recent approach for preventing complications in upper gastrointestinal endoscopic submucosal dissection

et al. 2021

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Although endoscopic submucosal dissection (ESD) is a minimally invasive treatment method for upper gastrointestinal (GI) tumors, patients undergoing upper GI ESD sometimes fall into a serious condition from complications. Thus, it is important to fully understand how to prevent complications when performing upper GI ESD. One of the major complications in esophageal and gastric ESD is intraoperative perforation. To prevent this complication, blind dissection should be avoided. Traction‐assisted ESD is a useful technique for maintaining good endoscopic view. This method was proven to reduce the incidence of intraoperative perforation, which would become a standard technique in esophageal and gastric ESD. In gastric ESD, delayed bleeding is the most common complication. Recently, a novel prediction model (BEST‐J score) consisting of 10 factors with four risk categories for delayed bleeding in gastric ESD was established, and a free mobile application is now available. For reducing delayed bleeding in gastric ESD, vonoprazan ≥20 mg/day is the sole reliable method in the current status. Duodenal ESD is still challenging with a much higher frequency of complications, such as perforation and delayed bleeding, than ESD in other organs. However, with the development of improved devices and techniques, the frequency of complications in duodenal ESD has been decreasing. To prevent intraoperative perforation, some ESD techniques, such as using the distal tips of the Clutch Cutter, were developed. An endoscopic mucosal defect closure technique would be mandatory for preventing delayed complications. However, several unresolved issues, including standardization of duodenal ESD, remain and further studies are demanded.

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Endo-anesthesia: a primer

Bazerbachi

White

Forbes

et al. 2022

Gastroenterology Report

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Gastrointestinal (GI) endoscopy has witnessed a Cambrian explosion of techniques, indications, and expanding target populations. GI endoscopy encompasses traditional domains that include preventive measures, palliation, as alternative therapies in patients with prohibitive risks of more invasive procedures, and indicated primary treatments. But, it has expanded to include therapeutic and diagnostic interventional endosonography, luminal endoscopic resection, third space endotherapy, endohepatology, and endobariatrics. The lines between surgery and endoscopy are blurred on many occasions within this paradigm. Moreover, patients with high degrees of co-morbidity and complex physiology require more nuanced peri-endoscopic management. The rising demand for endoscopy services has resulted in the development of endoscopy referral centers that offer these invasive procedures as directly booked referrals for regional and rural patients. This further necessitates specialized programs to ensure appropriate evaluation, risk stratification, and optimization for safe sedation and general anesthesia if needed. This landscape is conducive to the organic evolution of endo-anesthesia to meet the needs of these focused and evolving practices. In this primer, we delineate important aspects of endo-anesthesia care and provide relevant clinical and logistical considerations pertaining to the breadth of procedures.

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

Cited by 3 publications

References 5 publications

Impact of low pharyngeal/esophageal pressure associated with sarcopenia on postendoscopic submucosal dissection pneumonia in patients with superficial esophageal cancer

Impact of low pharyngeal/esophageal pressure associated with sarcopenia on postendoscopic submucosal dissection pneumonia in patients with superficial esophageal cancer

Recent approach for preventing complications in upper gastrointestinal endoscopic submucosal dissection

Endo-anesthesia: a primer

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