Dual-channel supraglottic airways may shorten insertion time and reduce hypoxemia during upper gastrointestinal proceduresDual Channel Airway Devices May Improve Efficiency During Endoscopy Procedures

BackgroundAirway management during upper gastrointestinal endoscopic procedures and other transesophageal instrumentation remains challenging because the airway and procedural device share the upper aerodigestive tract. Endoscopy-specific dual-channel supraglottic airways (dc-SGAs), including the LMA® Gastro™ Airway and the Jcerity Endoscoper™ Airway, are designed to maintain ventilation while permitting passage of an endoscope or transesophageal probe through a separate procedural channel. Nevertheless, their comparative efficacy and safety remain uncertain across heterogeneous procedures and comparator strategies.MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials comparing endoscopy-specific dc-SGAs with endotracheal tubes, other placed airway or access devices, or non-invasive oxygen therapy during upper gastrointestinal endoscopic or transesophageal instrumentation procedures. Observational studies were summarized narratively but were not included in pooled analyses.ResultsFifteen studies were included, including 13 randomized controlled trials involving 2,481 participants in the quantitative synthesis and 2 observational studies summarized narratively. Endoscopy-specific dc-SGAs showed comparable first-attempt airway device and endoscope/probe insertion success to comparator strategies and shortened airway device insertion time. Effects on endoscope/probe insertion time and endoscopist satisfaction were inconsistent and varied across comparator types. dc-SGAs reduced intraoperative hypoxemia, mainly in comparisons with non-invasive oxygen therapy. Postoperative sore throat showed a comparator-dependent pattern, with fewer events compared with endotracheal tubes but more events compared with non-invasive oxygen therapy.ConclusionEndoscopy-specific dc-SGAs may represent a feasible intermediate airway strategy for selected patients undergoing upper gastrointestinal endoscopic and transesophageal instrumentation procedures. They may improve airway placement efficiency and, compared with non-invasive oxygen therapy, reduce hypoxemia; however, these potential benefits should be interpreted in light of comparator-dependent throat discomfort, procedure heterogeneity, and the low-to-moderate certainty of evidence.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251182546, identifier [CRD420251182546].