Published online Nov 21, 2020. doi: 10.3748/wjg.v26.i43.6867
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
Hypoxemia by respiratory depression and airway obstruction during upper gastrointestinal endoscopy with sedation is a common concern. The nasal cannula is one of most convenient tools for supplemental oxygen, but it cannot overcome upper airway obstruction. Compared to the nasal prongs, the convenient nasopharyngeal airway provides improved efficiency of supplemental oxygen delivery during upper gastrointestinal endoscopy with sedation, but the insertion of the nasopharyngeal airway is an invasive procedure with a potential risk of airway injury.
In view of the significant limitations of available supplemental oxygen methods, it is necessary to identify new effective measures for supplemental oxygen during upper gastrointestinal endoscopy with sedation. The Wei nasal jet tube (WNJT) is a new design of special nasopharyngeal airway made of soft material. The available evidence indicates that with a low oxygen flow, compared to nasal cannula, the WNJT does not decrease the occurrence of hypoxemia during upper gastrointestinal endoscopy with propofol sedation. Given that increasing oxygen flow improves the efficacy of supplemental oxygen in the upper airway, we designed this study to compare the efficacy and safety of WNJT and nasal prongs for supplemental oxygen delivery during gastroscopy with sedation in patients with a normal body mass index when a moderate oxygen flow was provided.
In this study, we aimed 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.
To address 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, we designed this study as a prospective randomized controlled trial in which patients undergoing elective gastroscopy with propofol mono-sedation were randomized into one of two groups to receive either the WNJT or the nasal cannula supplemental oxygen with a 5-L/min flow. The primary endpoint was the incidences of hypoxemia or severe hypoxemia during gastroscopy.
A total of 291 subjects were randomized into two groups, but a total of only 144 patients were used for data analysis because 3 patients in the WNJT group were excluded. The total incidence of hypoxemia and severe hypoxemia during gastroscopy was significantly lower in the WNJT group than in the nasal cannula group. In the WNJT group, however, epistaxis by device insertion occurred in 7 patients.
With a moderate oxygen flow of 5 L/min, compared to nasal prongs, the WNJT is more effective for the prevention of hypoxemia during gastroscopy with propofol mono-sedation, but resulted in slight epistaxis in a few patients.
With a moderate oxygen flow of 5 L/min, the WNJT performs better than the nasal prongs for the prevention of hypoxemia during gastroscopy with propofol mono-sedation in patients with a normal body mass index. Thus, the WNJT may represent a useful tool for supplemental oxygen during gastroscopy with propofol mono-sedation. Because the WNJT insertion results in a risk of slight epistaxis in a few patients, the risk-benefit ratio of using the WNJT should be considered.