Cardiac and cerebral air embolism from endoscopic retrograde cholangio-pancreatography

Finsterer, Josef; Stöllberger, Claudia; Bastovansky, Adam

doi:10.1097/meg.0b013e32833c5459

Cited by 52 publications

(48 citation statements)

References 18 publications

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“…However, CO 2 insufflation would be required in cases of perforation of the duodenum following difficult endoscopic sphincterotomy (ES) or papillectomy, or in patients with choledocholithiasis after ES undergoing endoscopic treatment. This assumption is based on good absorption of CO 2 and previous reports of air embolism during ERCP [16,17].…”

Section: Discussionmentioning

confidence: 99%

Carbon dioxide insufflation during endoscopic retrograde cholangiopancreatography reduces bowel gas volume but does not affect visual analogue scale scores of suffering: a prospective, double-blind, randomized, controlled trial

et al. 2011

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Section: Discussionmentioning

confidence: 99%

Carbon dioxide insufflation during endoscopic retrograde cholangiopancreatography reduces bowel gas volume but does not affect visual analogue scale scores of suffering: a prospective, double-blind, randomized, controlled trial

et al. 2011

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“…Although air is commonly used for insufflation, it results in the retention of a large amount of residual gas after ESD. Residual gas in the gastrointestinal tract can induce post-ESD pain or discomfort, and in rare cases can give rise to life-threatening complications such as air embolism and tension pneumothorax [9][10][11][12][13][14][15][16][17] . It is well known that carbon dioxide (CO2) is absorbed faster in the body than air and is also rapidly excreted through the lungs, except in cases of pulmonary dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of carbon dioxide insufflation during gastric endoscopic submucosal dissection

Takada

Araki

Onogi

et al. 2015

WJG

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“…If air is injected as well, the appearances on CT scan are alarming, but no sequelae have been reported. • Portal vein air or bile embolism with fatality reported due to cardiac or brain air embolism [55]. This is potentially a concern with direct cholangioscopy.…”

Section: Rare Complicationsmentioning

confidence: 99%

Adverse events

Cotton

Elmunzer

2014

Ercp

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Key points• Endoscopists' experience, preprocedure risk assessment, early detection, and appropriate management of the adverse events of ERCP are the keys to minimize the risks.• Acute pancreatitis is the most common serious post-ERCP adverse event. Multiple patient-and procedure-related risk factors are identified. Prophylactic pancreatic stent placement and rectal nonsteroidal anti-inflammatory drugs (NSAIDs) decrease the rate of post-ERCP pancreatitis. The decision on using either or both methods should be individualized based on risk factors and expertise.• Perforation can occur as a result of guidewire penetration, sphincterotomy, luminal trauma, or stent migration. Conservative management is appropriate in most cases but most luminal perforations need surgical and/or endoscopic intervention.• Infection should be suspected when fever occurs following ERCP. Cholangitis when the procedure fails to provide drainage is the most worrisome infection but nosocomial infection, cholecystitis, or pancreatic sepsis can occur. Adequate drainage and antibiotic prophylaxis in high-risk patients decrease the risk.• Bleeding is considered an adverse event when it is evident after termination of ERCP. Coagulopathy is the most common risk factor. Correcting coagulopathy, endoscopic and endovascular examination and/or treatment, and surgery are the mainstay of management.• Cardiopulmonary, sedation-related, and stent-related complications are other adverse events. Rarely, death can occur as a consequence of post-ERCP complications.• The risk of medico-legal action after an adverse event is greatly reduced if the endoscopist and team communicate well and sympathetically with the patient and family before and after the procedure.

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Cardiac and cerebral air embolism from endoscopic retrograde cholangio-pancreatography

Cited by 52 publications

References 18 publications

Carbon dioxide insufflation during endoscopic retrograde cholangiopancreatography reduces bowel gas volume but does not affect visual analogue scale scores of suffering: a prospective, double-blind, randomized, controlled trial

Carbon dioxide insufflation during endoscopic retrograde cholangiopancreatography reduces bowel gas volume but does not affect visual analogue scale scores of suffering: a prospective, double-blind, randomized, controlled trial

Safety and efficacy of carbon dioxide insufflation during gastric endoscopic submucosal dissection

Adverse events

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