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Retained Food During Esophagogastroduodenoscopy Is a Risk Factor for Gastric-to-Pulmonary Aspiration

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Abstract

Background

Residual food (RF) during esophagogastroduodenoscopy (EGD) is thought, but not proven, to be a risk factor for gastric-to-pulmonary aspiration.

Aims

The aims of this study were to determine the prevalence of RF during EGD, to investigate whether RF was associated with an increased risk of aspiration, especially when monitored anesthesia care (MAC) or general anesthesia (GA) were administered, and to determine whether aspiration associated with RF led to a more severe clinical outcome.

Methods

Patients undergoing EGD between October 2012 and September 2018 were identified. Patient age, sex, aspiration events, RF, sedation type, structural foregut abnormalities, and diagnoses associated with impaired esophageal or gastric motility were noted. The clinical course after an aspiration event was evaluated.

Results

RF was identified during 4% of 81,367 EGDs. Aspiration events occurred during 41 (5/10,000) procedures. Aspiration was more likely to occur in patients with RF (odds ratio [OR] 15.1) or those receiving MAC or GA (OR 9.6 and 16.8 relative to conscious sedation, respectively). RF and MAC/GA were synergistically associated with increased odds of aspiration. In a multivariate nominal logistic regression model, older age (OR 2.6), MAC (OR 3.8), GA (OR 4.4), vagotomy (OR 5.2), achalasia (OR 3.8), and RF (OR 10.0) were risk factors for aspiration. Aspiration events in the presence or absence of RF led to similar clinical outcomes.

Conclusions

While aspiration events are rare in patients undergoing EGD, RF and the use of MAC or GA were associated with substantially increased odds of aspiration.

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Abbreviations

CI:

Confidence interval

EGD:

Esophagogastroduodenoscopy

GA:

General anesthesia

MAC:

Monitored anesthetic care

OR:

Odds ratios

RF:

Retained food

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Acknowledgments

The authors would like to thank Ms. Danette Bruns and the Anesthesia Clinical Research Unit for assistance with data extraction.

Funding

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Authors and Affiliations

  1. Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Aoife M. Feighery

  2. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA

    Nicholas R. Oblizajek, John League III, Navtej S. Buttar & David O. Prichard

  3. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA

    Matthew N. P. Vogt

  4. Division of Gastroenterology and Hepatology, The John Hopkins Hospital, Baltimore, MD, USA

    Danse Bi

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  1. Aoife M. Feighery
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  2. Nicholas R. Oblizajek
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  4. Danse Bi
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  5. John League III
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  7. David O. Prichard
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Correspondence to David O. Prichard.

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Feighery, A.M., Oblizajek, N.R., Vogt, M.N.P. et al. Retained Food During Esophagogastroduodenoscopy Is a Risk Factor for Gastric-to-Pulmonary Aspiration. Dig Dis Sci 68, 164–172 (2023). https://doi.org/10.1007/s10620-022-07536-2

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  • DOI: https://doi.org/10.1007/s10620-022-07536-2

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