Case Report: Esophageal balloon occlusion with a Foley catheter in high-risk sedated gastroscopy

Patients with altered upper gastrointestinal anatomy (such as after proximal gastrectomy) face a significantly elevated risk of gastro-esophageal reflux and pulmonary aspiration during sedated endoscopy. There is a need for safe sedation strategies in these high-risk cases.

We describe a 56-year-old male with a history of proximal gastrectomy and chronic reflux who required an upper endoscopy under sedation. To mitigate aspiration risk, an 18-Fr Foley catheter with an inflatable cuff was inserted transnasally into the mid-esophagus under light sedation and local anesthesia, and the balloon was inflated with 20 ml saline to occlude the esophageal lumen. The catheter's drainage port was connected to wall suction at a negative pressure of approximately -20KPa to aspirate any refluxate below the occlusion. After deepening sedation (MOAA/S score ≤ 2) with propofol and alfentanil (without endotracheal intubation), the endoscopy was performed while the esophageal balloon was gradually deflated under direct visualization. No obvious reflux or escape of gastric contents was observed during controlled deflation. The 8-min procedure was completed without hypoxemia, coughing, or any signs of aspiration, and the patient recovered without complications.

This case suggests that the use of esophageal balloon occlusion with negative-pressure suction was associated with safe, uneventful deep sedation in a patient at high risk of aspiration. The technique may serve as a simple, minimally invasive alternative to endotracheal intubation or awake endoscopy for airway protection in such high-risk patients, though further evaluation in larger studies is warranted.