Global 
Deutschland Esophagus to Small Intestine
Clin Gastroenterol Hepatol. 2026;24(1):113-120.e4
Nasal continuous positive airway pressure to reduce hypoxia in patients with obesity undergoing sedated [CM1.1]upper gastrointestinal endoscopy: A prospective randomized trial
Background and aims: Patients with obesity are at high risk of hypoxia during sedated upper gastrointestinal (GI) endoscopy, yet no standardized guidelines exist. This study evaluates the effectiveness of nasal continuous positive airway pressure (nCPAP) in reducing hypoxia during the procedure.
Methods: A prospective, randomized controlled study was conducted on patients with obesity (body mass index ≥ 30 kg/m2) scheduled for elective sedated upper GI endoscopy with propofol sedation. Patients were randomly assigned to receive either standard oxygen supplementation (nasal cannula [NC]) or nCPAP during the procedure. The primary outcome was the incidence of oxygen desaturation (SpO2 < 90%) during endoscopy. Secondary outcomes included the need for airway interventions, procedural success, patient tolerance, and adverse events.
Results: Of the 158 patients included, there were no significant differences in baseline characteristics between groups (male to female ratio, 71/87; mean age, 51 years; mean body mass index, 42.7 kg/m2). The incidence of desaturation was significantly lower in the nCPAP group (7.6%; 95% confidence interval [CI]: 1.7–13.5%) compared with the NC group (25.3%; 95% CI: 15.7–34.9%; p = 0.005). Patients in the nCPAP group maintained higher minimum SpO2 levels (97.1% ± 2.0%) than those in the NC group (95.9% ± 2.7%; p = 0.007). A multivariable logistic regression model identified age (1.06; 95% CI: 1.01–1.11) as an independent risk factor for desaturation, with odds ratio of 5.4 (95% CI: 2.0–16.8) for desaturation events in the NC group compared with the nCPAP group.
Conclusions: nCPAP significantly reduces hypoxia risk and stabilizes oxygen saturation in patients with obesity undergoing sedated GI endoscopy, supporting its routine use in these high-risk patients. Further studies should explore its broader clinical application.