Introduction: Esophagogastroduodenoscopy (EGD) requires adequate air infusion. However, cases of poor gastrointestinal wall extension due to frequent eructation have been reported. Sufficient gastrointestinal wall extension can be achieved by applying cricoid pressure during EGD. Herein, we evaluated the frequency of cases with poor gastrointestinal wall extension and the efficacy and safety of applying cricoid pressure during EGD. Methods: This interventional study included patients who underwent EGD between January 2020 and December 2020 at the JA Akita Koseiren Yuri Kumiai General Hospital. Cases wherein folds of the greater curvature of the upper gastric body were not sufficiently extended during EGD were considered to have poor gastrointestinal wall extension. In such cases, air infusion was performed while applying cricoid pressure. This procedure was considered effective when gastric wall extension was achieved. Results: A total of 2,000 patients were enrolled and underwent upper gastrointestinal endoscopy; however, five were excluded because of upper gastrointestinal tract stenosis. Observation of gastric wall extension of the greater curvature in the upper gastric body with normal air insufflation was difficult in 113 (5.7%) cases. Applying cricoid pressure was effective in 93 (82.3%) patients with poor gastric wall extension. Sufficient gastric wall extension was achieved within an average of 12.8 s in cases where cricoid pressure application was effective. No adverse events were associated with cricoid pressure application. Conclusions: Cricoid pressure application for patients with poor gastric wall extension during EGD is useful for ensuring a sufficient field of view during observation of the gastric body.

1.
Imagawa
A
,
Okada
H
,
Kawahara
Y
,
Takenaka
R
,
Kato
J
,
Kawamoto
H
, et al
.
Endoscopic submucosal dissection for early gastric cancer: results and degrees of technical difficulty as well as success
.
Endoscopy
.
2006
;
38
(
10
):
987
90
.
2.
Menon
S
,
Trudgill
N
.
How commonly is upper gastrointestinal cancer missed at endoscopy? A meta-analysis
.
Endosc Int Open
.
2014
;
2
(
2
):
E46
50
.
3.
Banks
M
,
Graham
D
,
Jansen
M
,
Gotoda
T
,
Coda
S
,
di Pietro
M
, et al
.
British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma
.
Gut
.
2019
;
68
(
9
):
1545
75
.
4.
Kang
DH
,
Choi
CW
,
Kim
HW
,
Park
SB
,
Kim
SJ
,
Nam
HS
, et al
.
Location characteristics of early gastric cancer treated with endoscopic submucosal dissection
.
Surg Endosc
.
2017
;
31
(
11
):
4673
9
.
5.
Schmulewitz
N
,
Baillie
J
.
Dieulafoy lesions: a review of 6 years of experience at a tertiary referral center
.
Am J Gastroenterol
.
2001
;
96
(
6
):
1688
94
.
6.
Jamanca-Poma
Y
,
Velasco-Guardado
A
,
Pinero-Perez
C
,
Calderon-Begazo
R
,
Umana-Mejia
J
,
Geijo-Martinez
F
, et al
.
Prognostic factors for recurrence of gastrointestinal bleeding due to Dieulafoy’s lesion
.
World J Gastroenterol
.
2012
;
18
(
40
):
5734
8
.
7.
Nojkov
B
,
Cappell
MS
.
Gastrointestinal bleeding from Dieulafoy’s lesion: Clinical presentation, endoscopic findings, and endoscopic therapy
.
World J Gastrointest Endosc
.
2015
;
7
(
4
):
295
307
.
8.
Wyman
JB
,
Dent
J
,
Heddle
R
,
Dodds
WJ
,
Toouli
J
,
Downton
J
.
Control of belching by the lower oesophageal sphincter
.
Gut
.
1990
;
31
(
6
):
639
46
.
9.
Inoue
H
,
Shimamura
Y
,
Rodriguez de Santiago
E
,
Kobayashi
Y
,
Ominami
M
,
Fujiyoshi
Y
, et al
.
Diagnostic performance of the endoscopic pressure study integrated system (EPSIS): a novel diagnostic tool for gastroesophageal reflux disease
.
Endoscopy
.
2019
;
51
(
8
):
759
62
.
10.
Sellick
BA
.
Cricoid pressure to control regurgitation of stomach contents during induction of anesthesia
.
Lancet
.
1961
;
19
:
404
6
.
11.
Toyonaga
H
,
Morita
S
,
Inokuma
T
,
Ezoe
Y
.
Cricoid pressure to prevent gastric deflation during esophagogastroduodenoscopy
.
VideoGIE
.
2018
;
3
(
3
):
102
5
.
12.
Horii
T
,
Ikehara
H
,
Kusano
C
.
Usefulness of cricoid pressure in patients with poor gastric wall extension as a result of eructation in upper gastrointestinal endoscopy
.
Dig Endosc
.
2019
;
31
(
6
):
e115
.
13.
Hill
LD
,
Kozarek
RA
,
Kraemer
SJ
,
Aye
RW
,
Mercer
CD
,
Low
DE
, et al
.
The gastroesophageal flap valve: in vitro and in vivo observations
.
Gastrointest Endosc
.
1996
;
44
(
5
):
541
7
.
14.
Kanda
Y
.
Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics
.
Bone Marrow Transplant
.
2013
;
48
(
3
):
452
8
.
15.
Chung
YF
,
Wong
WK
,
Soo
KC
.
Diagnostic failures in endoscopy for acute upper gastrointestinal haemorrhage
.
Br J Surg
.
2000
;
87
(
5
):
614
7
.
16.
Tack
J
,
Pandolfino
JE
.
Pathophysiology of gastroesophageal reflux disease
.
Gastroenterology
.
2018
;
154
(
2
):
277
88
.
17.
Fujiyoshi
Y
,
Inoue
H
,
Shimamura
Y
,
Fujiyoshi
MRA
,
Rodriguez de Santiago
E
,
Nishikawa
Y
, et al
.
Comparison of scope holding sigh on endoscopy and lower esophageal sphincter contraction on high-resolution manometry: a pilot study
.
DEN Open
.
2021
;
20
:
2:e50
.
18.
Rice
MJ
,
Mancuso
AA
,
Gibbs
C
,
Morey
TE
,
Gravenstein
N
,
Deitte
LA
.
Cricoid pressure results in compression of the postcricoid hypopharynx: the esophageal position is irrelevant
.
Anesth Analg
.
2009
;
109
(
5
):
1546
52
.
19.
Smith
KJ
,
Dobranowski
J
,
Yip
G
,
Dauphin
A
,
Choi
PT
.
Cricoid pressure displaces the esophagus: an observational study using magnetic resonance imaging
.
Anesthesiology
.
2003
;
99
(
1
):
60
4
.
20.
Boet
S
,
Duttchen
K
,
Chan
J
,
Chan
AW
,
Morrish
W
,
Ferland
A
, et al
.
Cricoid pressure provides incomplete esophageal occlusion associated with lateral deviation: a magnetic resonance imaging study
.
J Emerg Med
.
2012
;
42
(
5
):
606
11
.
21.
Petito
SP
,
Russell
WJ
.
The prevention of gastric inflation: a neglected benefit of cricoid pressure
.
Anaesth Intensive Care
.
1988
;
16
(
2
):
139
43
.
22.
Vanner
RG
.
Tolerance of cricoid pressure by conscious volunteers
.
Int J Obstet Anesth
.
1992
;
1
(
4
):
195
8
.
23.
Ralph
SJ
,
Wareham
CA
.
Rupture of the oesophagus during cricoid pressure
.
Anaesthesia
.
1991
;
46
(
1
):
40
1
.
24.
Hartsilver
EL
,
Vanner
RG
.
Airway obstruction with cricoid pressure
.
Anaesthesia
.
2000
;
55
(
3
):
208
11
.
25.
Walton
S
,
Pearce
A
.
Auditing the application of cricoid pressure
.
Anaesthesia
.
2000
;
55
(
10
):
1028
9
.
You do not currently have access to this content.