Fatal central venous air embolism: A rare complication of esophageal dilation by rendezvous

Zald, Philip B.; Andersen, Peter E.

doi:10.1002/hed.21304

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…EGD is a versatile procedure with diagnostic and therapeutic applications including the management of complex conditions (e.g., esophageal strictures) that often involve the rendezvous technique. Although complications associated with esophageal dilation are relatively rare, they can include esophageal or hypopharyngeal perforation, abdominal wall infection, stomach wall dehiscence, and pneumothorax [ 3 ]. Although rare, VAE is a severe and potentially fatal complication that is primarily iatrogenic and has been documented in various medical procedures, including sitting craniotomy, pars plana vitrectomy, cesarean delivery, and gastrointestinal procedures such as endoscopic retrograde cholangiopancreatography and EGD [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Notably, the insufflation pressure was not continuously monitored. Furthermore, exposure of the endoscope to radiation may have resulted in inflammatory changes, predisposing the esophagus to VAE [ 3 ]. A rapid reduction in ETCO 2 is a highly sensitive indicator of VAE at a threshold of 0.25 ml/kg of air and can be used to identify VAE in patients without hemodynamic compromise [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

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Venous air emboli during esophagoscopy confirmed by computed tomographic pulmonary angiography -a case report-

Tantisarasart,

Tantichamnankul,

Kitsiripant

et al. 2024

Korean J Anesthesiol

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Background: Esophagogastroduodenoscopy (EGD) is vital for the diagnosis and treatment of various gastrointestinal conditions but carries a low risk of venous air embolism (VAE). We report a case of VAE during EGD, confirmed by computed tomographic pulmonary angiography (CTPA). Case: A 56-year-old male with a history of hypopharyngeal cancer underwent EGD for dysphagia-related esophageal dilation. Signs of VAE were noted, prompting swift interventions, including oxygen therapy, positional changes, and CTPA. CTPA revealed the Mercedes-Benz sign, pneumomediastinum, and a minimal pneumothorax. The patient’s oxygen saturation improved within 30 min before undergoing CTPA, and he was discharged on postoperative day 4. Conclusions: Timely recognition of VAE, resulting in appropriate interventions supported by CTPA, resulted in favorable patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Venous air emboli during esophagoscopy confirmed by computed tomographic pulmonary angiography -a case report-

Tantisarasart,

Tantichamnankul,

Kitsiripant

et al. 2024

Korean J Anesthesiol

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“…Abscesses were the most common presentation of infections reported in published cases. Patient mortality was infrequent, occurring in only one case, reportedly 19 23 due to a venous air embolism.…”

Section: Discussionmentioning

confidence: 98%

Emerging techniques and efficacy of endoscopic esophageal reconstruction and lumen restoration for complete esophageal obstruction

2016

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Background and study aims: Complete esophageal obstruction (CEO) is a rare occurrence characterized by progressive esophageal stricture, which eventually causes lumen obliteration. With recent advances in flexible endoscopy, various innovative techniques exist for restoring luminal continuity.The primary aim of this study was to assess the efficacy and safety of patients undergoing combined antegrade-retrograde endoscopic dilation for CEO at our institution. The secondary aim was to review and highlight emerging techniques, outcomes, and adverse events after endoscopic treatment of CEO. Patients and methods: Our electronic endoscopy database was retrospectively reviewed to identify patients who underwent combined antegrade and retrograde endoscopy for CEO. Patient and procedural data collected included gender, age, technical success, pre- and post-dysphagia scores, and adverse events. Results: Six patients (67 % male, mean age 71.6 years [range 63 – 80]) underwent technically successful esophageal reconstruction with combined antegrade-retrograde endoscopy. All patients noted improvement in dysphagia with mean pre-procedure dysphagia score of 4 reduced to 1.33 (range 0 – 3) post-procedure. There were no adverse events and mean follow-up time was 17.3 months (range 3 – 48). Conclusions: Combined antegrade and retrograde endoscopic therapy for CEO is feasible and safe. We present our experience with endoscopic management of complete esophageal obstruction, and highlight emerging techniques, outcomes and adverse events related to this minimally invasive modality.

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“…A case of a fatal central venous air embolism has even been reported. 20 Accurately assessing complication rates is made difficult by the overall safety of the procedure. Even large patient series may lack the statistical power to accurately attribute a rate to these complications.…”

Section: Discussionmentioning

confidence: 99%

National Database Outcomes of Esophageal Dilations

et al. 2020

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Objectives/Hypothesis: To better assess rates of postoperative complications and mortality following esophageal dilation, and to identify factors associated with adverse outcomes.Study Design: Observational, retrospective cohort study. Methods: We queried a national database of insurance claims for Current Procedural Terminology (CPT) codes representing esophageal dilation performed between 2011 and 2017. Patients aged 18 to 100 who were continuously enrolled with their insurance provider were included. Demographic information, additional CPT codes, concomitant diagnoses, and anticoagulant medication data were collected for all patients included. Postoperative mortality was assessed and International Classification of Diseases (ICD)9/10 codes for complications, including esophageal perforation, hemorrhage, mediastinitis, and sepsis were flagged.Results: We identified 202,965 encounters for esophageal dilation. Of these procedures, 193 were performed on a patient who underwent percutaneous endoscopic gastrostomy (PEG) during the study period and was analyzed separately. Another 244 dilations were excluded due to repeat entries. Of the remaining 202,528 procedures remaining, 42,310 were repeat dilations in the same patient. Data analysis was confined to each patient's initial dilation. 160,218 initial dilations remained. Of these, 62,107 were performed on male patients and 98,111 were performed on female patients. The average age was 57.7 years. There were 12 mortalities within 30 days postoperatively, representing 0.0075% of all dilations. Esophageal perforation and esophageal hemorrhage were the most common reported complications, with 139 and 110 occurrences, respectively. The overall per-dilation complication rate was 0.215%.Conclusions: Evidence from a national insurance claim database suggests that esophageal dilation is a safe procedure with a low rate of serious complications and a 30-day all-cause mortality rate of less than 1 per 10,000 dilations.

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Fatal central venous air embolism: A rare complication of esophageal dilation by rendezvous

Abstract: To the best of our knowledge, this is the first report in the literature of fatal venous air embolism after dilation by rendezvous.

Cited by 6 publications

References 23 publications

Venous air emboli during esophagoscopy confirmed by computed tomographic pulmonary angiography -a case report-

Venous air emboli during esophagoscopy confirmed by computed tomographic pulmonary angiography -a case report-

Emerging techniques and efficacy of endoscopic esophageal reconstruction and lumen restoration for complete esophageal obstruction

National Database Outcomes of Esophageal Dilations

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