This is a 54-year-old male patient with a previous history of an 8mm 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 6mm pseudodepressed lesion (IIa+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).
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.
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”1 (Fig. 1). This maneuver can be easily learned.2 Although its effectiveness is controversial,3 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.
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.
