Table 1.
Comparison of Airway Devices Employed in Gastrointestinal Endoscopy
| Device | Principle of action | Advantages/benefits | Limitations |
|---|---|---|---|
| High-flow nasal cannula supportive oxygen therapy | Creation of CPAP | Decreased incidence of oxygen desaturation | Cost |
| Administration of 100% oxygen | Needs humidification | ||
| Prolongation of apnea time | Ability to increase CPAP by increasing oxygen flow rates | Xeromycteria, rhinalgia, pharyn- galgia, headache, and barotrauma | |
| Apneic insufflation of oxygen | |||
| Goudra’s bite block | Creation of CPAP | Decreased desaturation | Yet to be made available for commercial use |
| Administration of 100% oxygen | Incorporation of airway into the bite block | ||
| Prolongation of apnea time | Connection to the Mapleson breathing systems | ||
| Apneic insufflation of oxygen | Ability to provide IPPV | ||
| Procedural Oxygen Mask® (POM®) | Administration of near 100% oxygen | Prolongation of safe apnea time | Does not provide CPAP |
| Low risk of droplet transmission | Cost | ||
| Endoscopy face mask (DEAS endoscopic mask and VBM Endoscopy Mask) | A facemask with a provision for introduction of an upper gastrointestinal endoscope | Reduced incidence of desaturation | Cost |
| Allows IPPV and CPAP | Cumbersome to use | ||
| Endoscopic nasal mask (e.g., SuperNO2VA nasal PAP ventilation) | Allows IPPV during the performance of the procedure | Decreased incidence of desaturation | The self-sealing rigid cushion can potentially cause trauma, especially when used long term |
| Nasopharyngeal airway | Creation of CPAP | Easily available, the assembly of nasal airway and the Mapleson breathing systems can be easily mastered and implemented | Nasal bleed, occasional difficulty in the insertion of nasopharyn- geal airway |
| Administration of 100% oxygen | |||
| Prolongation of apnea time | |||
| Apneic insufflation of oxygen | |||
| Allows IPPV to a limited extent | |||
| Wei nasal jet tube | A special triple lumen nasal airway that allows jet ventilation, connection to a Mapleson breathing system and sampling of respiratory gas | Decreased incidence of desaturation | Cost and cumbersome to use; nasal bleeding |
| Gastro-Laryngeal Tube | A modified laryngeal tube placed in the supraglottic space; has a dedicated channel for the insertion of an endoscope | Reduced incidence of oxygen desaturation | Requires GA for insertion; higher stress response and trauma |
| LMA®GastroTM | Dual-channel laryngeal mask airway | Has a separate channel for introduction of endoscope including larger scopes for ERCP and endoscopic ultrasound | Requires GA for insertion; higher stress response and trauma |
| Reduced incidence of oxygen desaturation |
CPAP, continuous positive airway pressure; ERCP, endoscopic retrograde cholangiopancreatography; GA, general anesthesia; IPPV, intermittent positive pressure ventilation.