Scientific letter
Suboptimal endoscopic examination due to lack of gastric distension: How best to manage this situation? A case report
Exploración endoscópica subóptima por falta de distensión gástrica. ¿Como podemos manejar esta situación? A propósito de un caso
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A case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "59" "paginaFinal" => "60" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Montserrat Cornet-Vilallonga, Joaquim Profitós, Marta Rodríguez-Cornet, Manuela Ramos-Prada, Ignasi Puig" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Montserrat" "apellidos" => "Cornet-Vilallonga" "email" => array:1 [ 0 => "mcornet@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Joaquim" "apellidos" => "Profitós" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Marta" "apellidos" => "Rodríguez-Cornet" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Manuela" "apellidos" => "Ramos-Prada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Ignasi" "apellidos" => "Puig" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Endoscopy Unit, Consorci Sanitari de Terrassa, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Anaesthesia, Hospital Universitari Mútua de Terrassa, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Endoscopy Unit, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Exploración endoscópica subóptima por falta de distensión gástrica. ¿Como podemos manejar esta situación? A propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 811 "Ancho" => 2091 "Tamanyo" => 225184 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Schematic representation of the Sellick maneuver.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">This is a 54-year-old male patient with a previous history of an 8<span class="elsevierStyleHsp" style=""></span>mm gastric neuroendocrine tumor treated with EMR. The following year the patient underwent a monitoring upper GI endoscopy. In our Unit, endoscopies are usually performed under deep sedation with propofol. During the procedure, a new 6<span class="elsevierStyleHsp" style=""></span>mm pseudodepressed lesion (IIa<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>IIc) was detected in the proximal body of the stomach. However, the lesion could not be properly evaluated because the insufflated air was lost through the mouth, and it prevented the gastric cavity from distending. Biopsies were taken and showed another well-differentiated neuroendocrine tumor (G1).</p><p id="par0010" class="elsevierStylePara elsevierViewall">A new therapeutic upper GI endoscopy was scheduled. As in the previous examination, the lost air through the mouth prevented the gastric cavity from distending and performing the treatment with a proper view. The nurse in charge of the sedation, who was aware of the endoscopic problem, performed the Sellick maneuver. Then, the stomach could be properly distended, and the lesion could be easily removed with EMR. The histology showed a well differentiated neuroendocrine tumor (G1), with favorable prognostic factors and free margins.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In his original description, Sellick stated that “the maneuver consists of a temporary occlusion in the upper end of the esophagus by giving backward pressure using the index and the thumb fingers on the cricoid cartilage against the cervical spine”<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). This maneuver can be easily learned.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> Although its effectiveness is controversial,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> it is still used in the sequence of immediate orotracheal intubation in patients with absence of fasting to avoid regurgitation and reduce the risk of bronchoaspiration. In the case we are presenting, the occlusion of the esophageal lumen prevented the loss of air through the mouth and allowed a correct gastric distension.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">We believe that this incident is not exceptional, since the Sellick maneuver could help overcome this uncomfortable situation. We have performed this easy maneuver in similar cases with the same positive results. However, this technique requires some learning and should be carried out by anaesthesiologists or nurses trained in sedation, both skilled in this technique and its potential complications and side effects.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 811 "Ancho" => 2091 "Tamanyo" => 225184 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Schematic representation of the Sellick maneuver.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B.A. Sellick" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0140-6736(88)92883-8" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1961" "volumen" => "2" "paginaInicial" => "404" "paginaFinal" => "406" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2899818" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review and meta-analysis of cricoid pressure training and education efficacy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Beckford" 1 => "C. Holly" 2 => "R. Kirkley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/aorn.12150" "Revista" => array:6 [ "tituloSerie" => "AORN J" "fecha" => "2018" "volumen" => "107" "paginaInicial" => "716" "paginaFinal" => "725" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29851051" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of cricoid pressure compared with a sham procedure in the rapid sequence induction of anesthesia: the IRIS randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Birenbaum" 1 => "D. Hajage" 2 => "S. Roche" 3 => "A. Ntouba" 4 => "M. Eurin" 5 => "P. Cuvillon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamasurg.2018.3577" "Revista" => array:6 [ "tituloSerie" => "JAMA Surg" "fecha" => "2019" "volumen" => "154" "paginaInicial" => "9" "paginaFinal" => "17" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30347104" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/02105705/0000004500000001/v2_202201010823/S0210570521000194/v2_202201010823/en/main.assets" "Apartado" => array:4 [ "identificador" => "9030" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas científicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02105705/0000004500000001/v2_202201010823/S0210570521000194/v2_202201010823/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570521000194?idApp=UINPBA00004N" ]
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