Is your organization maximizing patient safety and minimizing liability in the GI endoscopy suite?

There are over 7.1 million upper GI endoscopies performed annually in the U.S. However, the anesthesiology literature clearly indicates that the majority of closed medical malpractice lawsuits arising from GI endoscopies are a result of respiratory complications, specifically hypoxia (dangerously low blood oxygen levels).

Anesthesia providers encounter and struggle with hypoxia in the GI endoscopy suite nearly every day. Less severe episodes, or "near misses," generally go unreported. But more serious episodes of hypoxia can result in prolongations, delays and cancellations of procedures and even cardiac arrests, brain damage and death.

The specific reasons for the frequent occurrence of inadequate oxygenation during upper endoscopy have been well delineated in the anesthesiology literature. Its occurrence is hardly surprising given that upper endoscopy entails the insertion of a large obstructing foreign body into the upper airway of a sedated patient.

However, one of the greatest historical technical challenges to providing adequate oxygenation during upper GI endoscopies results from the fact that we have been unable to use our best method of supplemental oxygen delivery, the traditional oxygen face mask, for the simple reason that the plastic dome of the facemask prevents insertion of the endoscope into the patient's mouth. As a result, for decades we have had to settle for our least effective method of oxygen delivery: nasal oxygen cannula.

While nasal cannula provide an "open face" to allow oral insertion of the endoscope, the room air which is entrained via the mouth with every breath dilutes and severely limits the oxygen actually delivered to the lungs to a maximum of 35 to 40 percent as opposed to the 85 to 100 percent oxygen concentrations that can be delivered by oxygen face masks.

In recent years, however, there has been a major breakthrough in this area. Several medical equipment companies have developed and commercialized oxygen face masks designed and FDA-approved for upper endoscopies.

We first became aware of these new endoscopy oxygen face masks in 2019 when our anesthesiology department launched a patient safety initiative to explore methods of reducing hypoxia during upper endoscopy after several adverse patient incidents occurred in our busy GI endoscopy suite. We discovered these endoscopy oxygen masks during a literature search and have been very impressed with the marked improvement in oxygen delivery ever since.

This paradigm shift to a superior oxygen delivery system for upper endoscopies represents an opportunity for an improvement in patient safety and a reduction in liability in the GI endoscopy suite.

I believe that endoscopy oxygen masks should replace nasal cannula and will soon become the clinical standard of care for upper endoscopy.

It is quite likely that they may already have become the medicolegal standard of care as it would be very difficult to justify and defend why a readily available, superior oxygen delivery device was not used should a serious hypoxic event occur.

Administration, risk management and organizational patient safety officers should be aware of this new paradigm in oxygen delivery for upper endoscopy and should discuss this important patient safety and risk management issue with the nursing and anesthesiology clinical leadership and clinicians in their GI endoscopy suite before the next "near miss" or tragedy occurs.


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