Efficacy of Overtube in Preventing Aspiration Pneumonia During Esophageal Endoscopic Submucosal Dissection

Aspiration pneumonia is a potential adverse event of esophageal endoscopic submucosal dissection (ESD). Using an overtube during esophageal ESD may reduce the amount of fluid refluxing into the oral cavity and prevent aspiration pneumonia. This study aimed to clarify the preventive effects of overtubes on aspiration pneumonia during esophageal ESD.

Between January 2015 and May 2020, 534 consecutive patients underwent esophageal ESD under intravenous anesthesia without endotracheal intubation at our hospital. Using propensity score matching and inverse probability of treatment weighting (IPTW), we retrospectively evaluated the risk factors and incidence of aspiration pneumonia during esophageal ESD.

A total of 393 patients who underwent esophageal ESD were enrolled. After matching, 99 matched pairs of patients either had an overtube used during esophageal ESD or did not. The overall incidence of aspiration pneumonia was 15.2%. The incidence of aspiration pneumonia was significantly higher in the non-overtube group than in the overtube group (22.2% vs. 8.1%; p = 0.009). Multivariate logistic regression analysis showed that non-use of an overtube was an independent risk factor for aspiration pneumonia (odds ratio [OR], 4.21; 95% confidence interval [CI], 1.66-10.65; p = 0.002). After adjustment with IPTW, non-use of an overtube also increased the risk of aspiration pneumonia (OR, 3.76; 95% CI, 1.54-9.21; p = 0.004).

Not using an overtube was a risk factor for aspiration pneumonia during esophageal ESD. Therefore, the use of an overtube is recommended to prevent aspiration pneumonia.

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