Effect of nasopharyngeal airway on hypoxemia in overweight and obese patients undergoing sedated endoscopy: A randomized trial

Hypoxemia is common during sedated gastrointestinal endoscopy (SGIE), especially in overweight and obese patients, yet the effectiveness of nasopharyngeal airways (NAs) for prevention remains unclear. This prospective randomized trial compared NA with standard nasal cannula (NC) in 256 overweight and obese patients. Results revealed that the NA group demonstrated a statistically significant reduction of hypoxemia (20/128 [15.6%] vs. 52/128 [40.6%]; p < 0.001) and severe hypoxemia (4/128 [3.1%] vs. 13/128 [10.2%]; p = 0.024), along with fewer jaw-thrust maneuvers (9/128 [7.0%] vs. 34/128 [26.6%]; p < 0.001), compared to the NC group. Multivariable analysis confirmed that higher STOP-BANG scores independently predicted hypoxemia risk, while the use of NA was an independent protective factor (odds ratio, OR, 0.23, 95% CI, 0.12-0.44, p < 0.001). These findings support using NA to reduce hypoxemia in high-risk patients and underscore the value of STOP-BANG for preoperative screening.