← Issue №7/ week of Aug 16, 2026/Endoscopy

Oropharyngeal airway integrated with capnography and oxygenation for sedated gastrointestinal endoscopy in obese patients: a randomised trial.

From GI Signals issue №7: what this paper found, what it changes, and where it sits against the current standard of care, reviewed by Simon Mathews, MD.

Endoscopy rct · n=591 · Aug 16, 2026 · Endoscopy · IF 11.8

Oropharyngeal airway integrated with capnography and oxygenation for sedated gastrointestinal endoscopy in obese patients: a randomised trial.

New therapysedationbariatric endoscopyendoscopy quality
Clinical takeawayUse the COMBO device during sedated endoscopy in obese patients (BMI ≥28) to substantially reduce hypoxia risk compared to standard nasal cannula. The device maintains airway patency and enables continuous capnography monitoring, providing an effective strategy for high-risk patients.
What it foundCOMBO device (oropharyngeal airway with capnography and oxygenation) reduced hypoxia (SpO2 75-90% for <60 seconds) from 21.50% to 6.38% (absolute difference -15.13%, 95% CI -20.59 to -9.66, p<0.001) and subclinical respiratory depression from 27.65% to 15.10% in obese patients (BMI ≥28) during sedated endoscopy, without increasing other adverse events.
ContextSedation-induced upper airway obstruction and hypoxia are recognized risks in obese patients undergoing endoscopy. Standard nasal cannulae provide supplemental oxygen but do not prevent airway collapse. This multicenter trial demonstrates an integrated airway management device is significantly more effective, refining risk-reduction strategy for this population.
Emergingsuggested applicable standard· ESGE/ESGENA 2026 (PMID 42480549); ESGE/ESGENA/ESA NAAP 2015; ASGE 2018; ASA 2018 moderate sedation; multisociety GLP-1 perioperative guidance 2024

… Assess ASA class, Mallampati, BMI, OSA risk and fasting status before every sedated procedure. … Involve an anesthesiology specialist for emergency endoscopy with increased aspiration risk, hemodynamic instability, OR significant comorbidities, and electively for ASA >=3, Mallampati >=3, severe OSA or anticipated difficult airway. …

From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text.

Our full summary of this standard

Scale pre-sedation assessment, regimen and monitoring to patient risk and procedure complexity. Assess ASA class, Mallampati, BMI, OSA risk and fasting status before every sedated procedure. Propofol AND midazolam-with-opiate are both strongly recommended; propofol as first line is conditioned on national legislation and staffing, not on demonstrated superiority. Consider remimazolam in the elderly and in cardiorespiratory comorbidity. Whoever administers sedation must be able to rescue a patient one level deeper than intended. Involve an anesthesiology specialist for emergency endoscopy with increased aspiration risk, hemodynamic instability, OR significant comorbidities, and electively for ASA >=3, Mallampati >=3, severe OSA or anticipated difficult airway. Individualize GLP-1 receptor agonist management rather than withholding blindly. Discharge against a scoring system with an accompanying adult and 24-hour restrictions.

ESGE/ESGENA 2026 (PMID 42480549); ESGE/ESGENA/ESA NAAP 2015; ASGE 2018; ASA 2018 moderate sedation; multisociety GLP-1 perioperative guidance 2024 ↗
Xu M … Su D · Endoscopy · IF 11.8 · PubMed ↗Permalink
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