We read with great interest the article by Zilberman et al. regarding modification of the LMA® Gastro™ airway(LGA). We commend them for their thoughtful improvisation, but the clinical scenario is very different, and its practical utility is doubtful.
The authors have cut the device close to the ‘knee’ well above the mask. This arrangement will defeat the very purpose of LGA and will only help guide the endoscope till the pharynx. The inflated mask can still compress the endoscope and hinder any advancement or rotational movements during ERCP. Rough edges created are likely to graze on the pharyngeal mucosa and cause injury.
The authors mention that gastro channel is 14 mm wide.However, it has a uniform 16 mm lumen without any ‘knee’ and is suitable for all endoscopes up to 14 mm The diameter of most gastro-duodenoscopes is 13.1-13.7 mm and only 2 mm play is required for the passage of endoscopes in thelumen. In our clinical experience, a well-lubricated shaft helps navigate even bigger endoscopes and any resistance is generally felt only at its distal end. Use of silicon spray provided us a better lubrication then use of a jelly. A large series in the past has reported 99% success for gastroduodenoscopies with high endoscopist satisfaction using LGA.
We think that further design modifications like wider gastro-channel, reinforcement of the distal end of the LGA to reduce compression by inflated cuff, making the distal tip more oblong would go a longway in overcoming the present limitations and increasing its acceptance.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
1. Zilberman P, Davidovics Z, Benson AA A bench test of a modified gastro LMA for the insertion of the duodenoscope Indian J Anaesth 2022 66 159 60
2. Sorbello M Evolution of supraglottic airway devices:The Darwinian perspective Minerva Anestesiol 2018 84 297 300
3. Schmutz A, Loeffler T, Schmidt A, Goebel U LMA Gastro™airway is feasible during upper gastrointestinal interventional endoscopic procedures in high risk patients:A single-center observational study BMC Anesth 2020 20 1 7 doi:10.1186/s12871-020-0938-9
4. Terblanche NC, Middleton C, Choi-Lundberg DL, Skinner M Efficacy of a new dual channel laryngeal mask airway, the LMA®GastroTM Airway, for upper gastrointestinal endoscopy:A prospective observational study Br J Anaesth 2018 120 353 60