Clinical Trials Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2020; 26(43): 6867-6879
Published online Nov 21, 2020. doi: 10.3748/wjg.v26.i43.6867
Comparison of two supplemental oxygen methods during gastroscopy with propofol mono-sedation in patients with a normal body mass index
Liu-Jia-Zi Shao, Yi Zou, Fu-Kun Liu, Lei Wan, Shao-Hua Liu, Fang-Xiao Hong, Fu-Shan Xue
Liu-Jia-Zi Shao, Yi Zou, Fu-Kun Liu, Lei Wan, Shao-Hua Liu, Fang-Xiao Hong, Fu-Shan Xue, Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Shao LJZ and Zou Y contributed equally to this study, study design/planning, study conduct, data analysis, and writing and revising the paper; Liu FK assisted with study conduct, data analysis, and revising the paper; Wan L assisted with study design/planning, study conduct, data analysis, and revising the paper; Liu SH assisted with study conduct, data analysis and curation, and revising the paper; Hong FX assisted with study design/planning, study conduct, data analysis, and revising the paper; Xue FS assisted with study design/planning, study conduct, and writing and revising the paper.
Supported by “Renfu” Research Fund by Chinese Society of Digestive Endoscopy, No. CSDE012017120006.
Institutional review board statement: This study was approved by the Institutional Ethics Committee of Beijing Friendship Hospital, China (Ethics Committee number: 2017-P2-009-02).
Clinical trial registration statement: This study is registered with the Chinese Clinical Trial Registry (registration No. ChiCTR-IOR-17013089).
Informed consent statement: The written informed consent was obtained from each patient included in the study.
Conflict-of-interest statement: No external funding or competing interests declared.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fu-Shan Xue, MD, Professor, Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, Beijing 100050, China. fushanxue@outlook.com
Received: July 19, 2020
Peer-review started: July 19, 2020
First decision: August 8, 2020
Revised: August 10, 2020
Accepted: October 20, 2020
Article in press: October 20, 2020
Published online: November 21, 2020
Abstract
BACKGROUND

Hypoxemia due to respiratory depression and airway obstruction during upper gastrointestinal endoscopy with sedation is a common concern. The Wei nasal jet tube (WNJT) is a new nasopharyngeal airway with the ability to provide supraglottic jet ventilation and oxygen insufflation via its built-in wall channel. The available evidence indicates that with a low oxygen flow, compared with nasal cannula, the WNJT does not decrease the occurrence of hypoxemia during upper gastrointestinal endoscopy with propofol sedation. To date, there has been no study assessing the performance of WNJT for supplemental oxygen during upper gastrointestinal endoscopy with sedation when a moderate oxygen flow is used.

AIM

To determine whether the WNJT performs better than the nasal prongs for the prevention of hypoxemia during gastroscopy with propofol mono-sedation when a moderate oxygen flow is provided in patients with a normal body mass index.

METHODS

This study was performed in 291 patients undergoing elective gastroscopy with propofol mono-sedation. Patients were randomized into one of two groups to receive either the WNJT (WNJT group, n = 147) or the nasal cannula (nasal cannula group, n = 144) for supplemental oxygen at a 5-L/min flow during gastroscopy. The lowest SpO2 during gastroscopy was recorded. The primary endpoint was the incidence of hypoxemia or severe hypoxemia during gastroscopy.

RESULTS

The total incidence of hypoxemia and severe hypoxemia during gastroscopy was significantly decreased in the WNJT group compared with the nasal cannula group (P = 0.000). The lowest median SpO2 during gastroscopy was significantly higher (98%; interquartile range, 97-99) in the WNJT group than in the nasal cannula group (96%; interquartile range, 93-98). Epistaxis by device insertion in the WNJT group occurred in 7 patients but stopped naturally without any treatment. The two groups were comparable in terms of the satisfaction of physicians, anesthetists and patients.

CONCLUSION

With a moderate oxygen flow, the WNJT is more effective for the prevention of hypoxemia during gastroscopy with propofol mono-sedation compared with nasal prongs, but causing slight epistaxis in a few patients.

Keywords: Gastroscopy, Hypoxemia, Wei nasal jet tube, Nasal cannula, Supplemental oxygen, Adverse outcomes

Core Tip: This study is a prospective randomized controlled trial aimed to determine whether the Wei nasal jet tube (WNJT) performs better than the nasal prongs for the prevention of hypoxemia during gastroscopy with propofol mono-sedation when a moderate oxygen flow is provided in patients with a normal body mass index. Our results show that compared with nasal prongs for supplemental oxygen, the WNJT is more effective for the prevention of hypoxemia during gastroscopy with propofol mono-sedation when a moderate oxygen flow is provided. However, the WNJT caused slight epistaxis in a few patients.