Large‐bore suctioning for esophageal clearance under endoscopic vision

Abstract

Dear Editor, Esophageal food residue may play a critical role in the induction of ventilatory adverse events during an upper endoscopy. While concepts similar to bolus obstruction and/or foreign body removal are well established to this effect, here, I present a novel easy-to-implement emergency approach as large-bore suctioning for esophageal clearance under endoscopic vision. A 64-year-old, mentally impaired patient presented for implantation of a biodegradable esophageal stent due to a benign high-grade esophageal stricture related to refractory esophagitis dissecans. During introduction of the 9.2 mm standard-size upper endoscope into the esophagus under deep sedation using midazolam and propofol, a solid food residue was observed in the upper sphincter most likely representing parts of an orange (Figure 1A,B). Prior to proceeding with stent implantation, removal was considered indicated to circumvent aspiration. To this end, the 25-Fr suction unit was detached from the endoscope and inserted along the scope axis into the esophagus without suction. After adequate contact with the food residue, maximum suction was applied. (Figure 1C) Given a diameter mismatch, the food residue could not be suctioned through, but it was instead carefully withdrawn together with the endoscope orally while maintaining suction (Figure 1D). Unlike a similar approach introduced for advanced achalasia, taping the suction tube to the scope's tip, the presented ad hoc applicable technique circumvents repeated esophageal intubation and might, thus, be more instrumental in rapid esophageal food residue clearance, blocking, and safeguarding the route to the airway.1 The procedure time was estimated at <5 minutes, and no adverse events such as mucosal erythema, bleeding, and/or perforation occurred. The author declares no conflict of interest.