Modified supraglottic airway for gastroscopy: an advance in patient safety?

In this edition of the British Journal of Anaesthesia, Terblanche and colleagues1 describe their preliminary clinical experiences with the LMA® Gastro™, a modified supraglottic airway designed for airway maintenance and security during upper gastrointestinal endoscopy. Thirty anaesthetists successfully deployed the device in 290/292 patients. Endoscopy was achieved in 98%.

Clinicians are here presented with a new device designed for a single clinical circumstance (albeit a common one). We should, therefore, ask whether the problem that the device sets out to solve is real, whether the device addresses it effectively, and reflect whether the apparatus is a useful addition to the clinical environment. The LMA® Gastro™ is not the only contender in this product area. Recently, an ‘endoscopic mask’ has been described, but that device appears to comprise a face mask with an integrated Guedel airway and no form of airway protection from aspiration of gastric contents.2, 3

Terblanche and colleagues1 report an observational study that does not include a control group (i.e. the equivalent of a Phase 2 pharmaceutical study). The patients were relatively fit (ASA I and II) and described by the authors as ‘at low risk of pulmonary aspiration’. This study design is a rational starting point for new equipment, but only offers us information relevant to the patients included.

Whilst the high rates of airway insertion and successful endoscopy are to be welcomed, we now need to see randomized comparisons with alternative techniques in the typically straightforward patient group already studied. Appropriate comparators include the unprotected airway and alternative airway management devices.