Comparison of LMA® gastro airway and gastro-laryngeal tube in endoscopic retrograde cholangiopancreatography: a prospective randomized observational trial.

BACKGROUND New generation airway devices with different designs have been developed as an alternative to endotracheal intubation in order to avoid adverse events associated with sedation in endoscopic procedures and to provide patent airway. We aimed to compare two supraglottic airway devices (SGADs), the LMA®GastroTM Airway and Gastro Laryngeal Tube (GLT), in terms of airway efficiency, performance during procedure and adverse events in Endoscopic Retrograde Cholangiopancreatography (ERCP). METHODS A hundred-three ERCP patients without high risk of aspiration were included. Patients were randomly allocated to the LMA Gastro and GLT groups. The primary study outcomes were the comparison of the two SGADs in terms of oropharyngeal leak pressure (OLP). Secondary study outcome was SGADs-related adverse events. RESULTS Procedures were completed with SGADs in fifty patients in each group. The rate of successful insertion at first attempt was 72% in GLT and 96% in LMA Gastro (p=0.004). The mean OLP of LMA Gastro Group (31.8cm H2O) was significantly higher than that of the GLT Group (26.5cm H2O), (p=0.0001). However endoscopists' satisfaction was higher in GLT (p=0.0001). Mucosal damage and sore throat were lower in LMA Gastro Group. CONCLUSIONS LMA® Gastro™ had a higher OLP than GLT. However, GLT was better for endoscopist satisfaction, as it provides more satisfying maneuverability. As to secondary outcome advers events were lower in LMA® Gastro™. The lower complication rates associated with the device and providing a more patent airway also highlighted the apparent clinical efficacy of LMA® Gastro™ than GLT, in ERCP.