Clinical utility and safety of LMA Gastro™ in ASA III–IV patients with chronic liver disease undergoing upper gastrointestinal endoscopy: A prospective observational study

Background: Patients with chronic liver disease (CLD) and American Society of Anaesthesiologists (ASA) physical status III–IV present significant challenges in airway management during upper gastrointestinal endoscopy (UGIE). Deep sedation without a secured airway increases the risk of hypoxemia and respiratory complications, while endotracheal intubation may delay recovery. The LMA Gastro™ is a second-generation supraglottic airway device designed to maintain airway patency while allowing endoscopic access. However, its safety and efficacy in high-risk CLD patients remain insufficiently addressed in the literature. This study aimed to evaluate the clinical utility and safety of LMA Gastro™ in this specific population.Materials and Methods: In this prospective observational study, 105 ASA III–IV CLD patients undergoing UGIE were administered intravenous propofol anaesthesia, and standardized insertion of the LMA Gastro™ was performed. Anaesthesia was maintained using a volatile agent in an oxygen-air mixture. The primaryoutcome was the success rate of endoscope insertion and ease of endoscope passage. Secondary outcomes included LMA Gastro™ insertion success rate, first-attempt success rate, mean insertion time, lowest oxygen saturation during the procedure, as well as the occurrence of any adverse events such as laryngospasm, bloodstaining of the device, or postoperative sore throat.Results: The success rate of endoscope insertion was 96.0% with a 95% confidence interval (CI) of 92.3–99.8%. The overall insertion success rate for LMA Gastro™ was 97.1% with a 95% CI of 93.98–100%, and the first-attempt success rate was 92.4%. The mean insertion time for the LMA Gastro™ was 32.4 ± 5.5 seconds. Postoperative sore throat occurred in 34.7% of the patients, and blood staining on the device was observed in 50.5% of the cases. Importantly, no serious adverse events, such as desaturation, laryngospasm, or bronchospasm, were reported during or after the procedure.Conclusion: LMA Gastro™ in ASA III–IV patients with chronic liver disease undergoing upper gastrointestinal endoscopy demonstrates high procedural success with minimal complications. The device offers a reliable alternative to deep sedation or endotracheal intubation, ensuring effective airway management while minimizing risks in this high-risk population.