Bronchoaspiration During Endoscopy Under Sedation in a Patient with a History of Gastrectomy and Prolonged Fasting: A Case Report

Key Takeaways for GI Nurses

• Patients with gastrectomy history require heightened pre-procedural assessment and modified fasting protocols due to altered gastric anatomy and emptying patterns
• Standard fasting guidelines may be inadequate for post-gastrectomy patients, as altered gastric physiology can lead to unexpected gastric contents despite prolonged NPO status
• Enhanced aspiration precautions and airway monitoring are essential when sedating patients with previous gastric surgery, regardless of fasting duration
• Pre-procedural gastric decompression should be strongly considered in gastrectomy patients to minimize aspiration risk during endoscopic procedures under sedation

Clinical Relevance

This case report highlights a critical gap in standard pre-procedural protocols for patients with altered gastric anatomy. For endoscopy nurses, this underscores the importance of comprehensive surgical history assessment during pre-procedure screening. Patients with gastrectomy often have compromised gastric motility, delayed emptying, and anatomical changes that can predispose them to retained gastric contents even after extended fasting periods. This knowledge should prompt nurses to advocate for modified preparation protocols and enhanced monitoring strategies.

The case has immediate implications for unit safety protocols and risk stratification procedures. Endoscopy units should consider developing specialized pre-procedural checklists for post-gastrectomy patients that include assessment of gastric emptying, consideration of gastric decompression, and heightened sedation monitoring protocols. Nursing staff should be educated on the physiological changes following gastrectomy and how these alterations impact standard NPO effectiveness. This may require collaboration with anesthesia providers to determine appropriate sedation approaches and airway management strategies for this high-risk population.

From a professional development perspective, this case emphasizes the need for ongoing education about post-surgical anatomy and its impact on endoscopic procedures. GI nurses must understand that standard protocols may not apply universally and that individualized patient assessment remains paramount. This reinforces the critical role of experienced nursing judgment in identifying patients who may require modified approaches to achieve optimal procedural safety outcomes.

Bottom Line

GI nurses must recognize that patients with gastrectomy history represent a high-risk population for aspiration during sedated endoscopy, regardless of fasting duration, and should advocate for enhanced pre-procedural assessment, consider gastric decompression, and implement heightened monitoring protocols to prevent this potentially life-threatening complication.