Clinical Usefulness of Nasopharyngeal Airway (NPA) In Snoring Patients During Gastric Endoscopic Submucosal Dissection

Aims When sedative ESD is performed, snoring or sleep apnea sometimes occurs, which can lead to SpO2 decrease. Snoring increases the movement of the diaphragm. Result in increased movement of target lesion during procedure. This makes Knife difficult to cut in the desired position. There is a study suggesting that the use of NPA improves the reduction of SpO2 in sedative endoscopy.

The purpose of this study is to evaluate the stability of target lesion movement, convenience and safety of the procedure when NPA are used in snoring patients during sedative gastric ESD.

Methods All patients who received ESD (with or without NPA apply) were sedated using propofol. In the intervention group a Nasopharyngeal airway was inserted once the patients reached the desired level of sedation. The primary outcome measure was dissection time and total procedure time of the procedure when NPA are used in snoring patients under ESD. Secondary outcome measures included SpO2 (%) and target lesion movement (graded score 0~5 point,

0: no movement,

1: a little,

2: mild,

3: moderate,

4: severe,

5: very severe movement) before and after NPA apply.

Results 22 cases were performed ESD using NPA. 12 cases were performed ESD non-using NPA. There was no difference in procedure time between the two groups. Five cases reported reduced SpO2 under 90 % before ESD. There was an increase in oxygen saturation upper 95 % after the NPA was applied. When comparing before and after using NPA apply, NPA group was less target lesion movement fluctuation. (before vs after NPA apply movement score: 4 vs 1).

Conclusions

Table 1. Charateristics

Charateristics	Mean+SD
Age	65.4+12.0
Sex (M:F)	14:8
BMI	25.3+3.8
Mallampati score	2(36.3 %) 3(59.1 %) 4(4.6 %)
Pre-Procedure sP02(%)	95.8+4.2 %

Table 2. Comparing before and after using NPA apply

	Pre-NPA	NPA apply	P-value
Dissection time (min)	16.25	19.42	0.864[*]
total procedure time	36.366	38.46	0.319[*]
Resection (cm)	36.5	43.33	0.045[*]

* p value calculated by using the wilcoxon

Table 3. Five Pre-Procedure desaturation event cases

	Non-APA saturation (%)	NPA Apply saturation (%)	Mallampati score	Dessection time m(in)	Resection size	Location	Pathology
case 1	97(%)	97(%)	3	24	40mm	Lowbody/Lesser	High grade dysplasia
case 2	97(%)	97(%)	4	23	20mm	Midboy/Lesser	Neuroendocine
case 3	97(%)	97(%)	3	20	30mm	Lowbody/Anterior	High grade dysplasia
case 4	97(%)	97(%)	3	13	35mm	Antrum/Lesser	Low grade dysplasia
case 5	97(%)	97(%)	3	19	40mm	Angle	adenocarinoma/MD

ESD with NPA apply is lead to avoidance of fatal respiratory complications during ESD under propofol-induced sedation.ESD with NPA apply is lead to a successful ESD snoring patients with severe target lesion movement.

Citation: Seo J, Jeen YT, Bang EJ et al. eP164 CLINICAL USEFULNESS OF NASOPHARYNGEAL AIRWAY (NPA) IN SNORING PATIENTS DURING GASTRIC ENDOSCOPIC SUBMUCOSAL DISSECTION. Endoscopy 2021; 53: S149.

Publication History

Article published online:
19 March 2021