Should SGAs be avoided in patients with esophageal disease
Question# 681
I have a question concerning the contraindication in the Supraglottic Airway Medical Directive. The "Known esophageal disease (varices)" do also include all the esophageal disease like example eosinophilic esophagitis, dysphagia, esophagitis, Barrett's esophagus, gastroesophageal reflux disease (GERD), esophageal cancer or only varices in the esophageal? I was just wondering because there is a good amount of patient and specially elderly patient that are diagnosed with GERD.
Answer:
The concern with disease of the oropharynx or proximal esophagus when placing a SGA is the risk of irritating something that could bleed and complicate the airway.
Esophageal varices and esophageal cancer are the most likely esophageal diseases to cause a significant hemorrhage if perforated during SGA placement.
GERD is not typically associated with significant esophageal hemorrhage, thus it is acceptable to place an SGA in this patient.
In most other diseases of the esophagus the risk of tears or ulcers at the proximal end of the esophagus is low, thus the potential harm of an SGA is low; therefore these are not a contraindication. However, if you are informed that a patient has esophageal ulcers or other disease (excluding GERD) it may be best to avoid SGAs that enter the esophagus, such as the King LTA, and rather chose bag-mask-ventilation or the placement of an LMA or iGel.
References
Kathi, P.R., et al. 2018. Esophageal arteriovenous malformation, a rare cause of significant upper gastrointestinal bleeding: Case report and review of literature. https://pubmed.ncbi.nlm.nih.gov/30181941
Laurin, E.G.. 2022. Extraglottic devices for emergency airway management in adults.
Ozdogan, E., et al. 2020. Upper Gastrointestinal Bleeding as the First Presentation of Eosinophilic Gastrointestinal Disease. https://journals.lww.com/jpgnr/fulltext/2020/11000/upper_gastrointestinal_bleeding_as_the_first.16.aspx
Rockey, D.C. 2022. Causes of upper gastrointestinal bleeding in adults. https://www.uptodate.com/contents/causes-of-upper-gastrointestinal-bleeding-in-adults