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Sato H, Kawabata H, Fujiya M. Gel immersion in endoscopy: Exploring potential applications. World J Gastroenterol 2025; 31:101288. [PMID: 39877706 PMCID: PMC11718643 DOI: 10.3748/wjg.v31.i4.101288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 11/19/2024] [Accepted: 12/06/2024] [Indexed: 12/30/2024] Open
Abstract
The challenge of effectively eliminating air during gastrointestinal endoscopy using ultrasound techniques is apparent. This difficulty arises from the intricacies of removing concealed air within the folds of the gastrointestinal tract, resulting in artifacts and compromised visualization. In addition, the overlap of folds with lesions can obscure their depth and size, presenting challenges for an accurate assessment. Conversely, in intricately folded regions of the gastrointestinal tract, such as the stomach, intestine, and colon, insufficient delivery of air or CO2 into the cavity impedes luminal expansion, hindering the accurate visualization of lesions concealed within the folds. Although this underscores the requirement for substantial airflow, excessive airflow can hinder visualization of bleeding lesions and other abnormalities. Considering these challenges, an ideal endoscopic device would facilitate the observation of lesions without the requirement for air or CO2 delivery whereas, ensuring optimal expansion of the gastrointestinal tract. Recently, transparent gels with specific viscosities have been employed more frequently to address this issue. This review aims to elucidate how these gels address these challenges and provide a solution for enhanced endoscopic visualization.
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Affiliation(s)
- Hiroki Sato
- Department of Internal Medicine, Asahikawa Medical University, Asahikawa 078-8510, Hokkaido, Japan
| | - Hidemasa Kawabata
- Department of Internal Medicine, Asahikawa Medical University, Asahikawa 078-8510, Hokkaido, Japan
| | - Mikihiro Fujiya
- Department of Internal Medicine, Asahikawa Medical University, Asahikawa 078-8510, Hokkaido, Japan
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Murate K, Nakamura M, Yamamura T, Maeda K, Sawada T, Ishikawa E, Kida Y, Esaki M, Hamazaki M, Iida T, Mizutani Y, Yamao K, Ishikawa T, Furukawa K, Ohno E, Honda T, Ishigami M, Kinoshita F, Ando M, Kawashima H. CO 2 enterography in endoscopic retrograde cholangiography using double-balloon endoscopy: A randomized clinical trial. J Gastroenterol Hepatol 2023; 38:761-767. [PMID: 36648892 DOI: 10.1111/jgh.16112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/22/2022] [Accepted: 01/14/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIM Double-balloon endoscopic retrograde cholangiography (DBERC) is a valuable procedure for patients with altered gastrointestinal anatomy. Nonetheless, it is time-consuming and burdensome for both patients and endoscopists, partly because route selection in the reconstructed bowel with complicating loop is challenging. Carbon dioxide insufflation enterography is reportedly useful for route selection in the blind loop. This prospective randomized clinical trial investigated the usefulness of carbon dioxide insufflation enterography for route selection by comparing it with conventional observation. METHODS Patients scheduled to undergo DBERC were consecutively registered. They were divided into carbon dioxide insufflation enterography and conventional groups via randomization according to stratification factors, type of reconstruction methods, and experience with DBERC. The primary endpoint was the correct rate of initial route selection. The secondary endpoints were the insertion time, examination time, amount of anesthesia drugs, and complications. RESULTS The correct rate of route selection was significantly higher in the carbon dioxide insufflation enterography group (23/25, 92%) than in the visual method (15/25, 60%) (P = 0.018). The insertion time was significantly shorter in the carbon dioxide insufflation enterography group than in the visual group (10.8 ± 11.1 min vs 29.8 ± 15.7 min; P < 0.001). No significant differences in complications were noted between the two groups. The amounts of sedatives and analgesics used were significantly lower in the carbon dioxide insufflation enterography group (P < 0.001 and P < 0.001, respectively). CONCLUSIONS Carbon dioxide insufflation enterography can reduce the burden of DBERC on patients and endoscopists by shortening the examination time and reducing the amount of medication.
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Affiliation(s)
- Kentaro Murate
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keiko Maeda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsunaki Sawada
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichi Kida
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaya Esaki
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Motonobu Hamazaki
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadashi Iida
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuyuki Mizutani
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kentaro Yamao
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumie Kinoshita
- Center for Advanced Medical Care, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiko Ando
- Center for Advanced Medical Care, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Patterson KN, Beyene TJ, Minneci PC, Diefenbach KA. Rates of Air Embolism in Pediatric Patients Undergoing Surgical Procedures of the Peritoneum. J Laparoendosc Adv Surg Tech A 2022; 32:1220-1227. [PMID: 36318787 DOI: 10.1089/lap.2022.0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Air embolism during laparoscopic surgery is a rare but feared complication in the pediatric population. The objective of this study was to identify rates of air embolus in pediatric patients during hospitalization for laparoscopic or open surgical procedures of the peritoneal cavity. Materials and Methods: Patients 0-18 years old within the Pediatric Health Information System who underwent a predefined, common inpatient laparoscopic or open surgical procedure involving the peritoneal cavity from 2015 to 2020 were studied. International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for air embolism were then searched among patients during the same admission. Firth logistic regression was used to compare rates of air embolism in open and laparoscopic cohorts and in patients >1 and ≤1 year. Results: Unadjusted rates of air embolism were higher in patients undergoing open compared with laparoscopic surgery (open: 9/45,080; 20.0/100,000 patients versus laparoscopic: 3/101,892; 2.9/100,000 patients). In patients ≤1 year (45,726), 2 patients undergoing open surgery (2/1,031; 9.5/100,000 patients) and all 3 patients undergoing laparoscopic surgery had an air embolism diagnosis (3/22,329; 13.4/100,000 patients). For laparoscopic surgery, a suggested lower relative risk (RR) of air embolism was demonstrated for children >1 year compared with children ≤1 year (RR: 0.05, P = .05). Conclusion: Air embolism associated with common pediatric surgical procedures of the peritoneum is rare and patients undergoing laparoscopic and open surgery have similar risks for air embolism. Although rare, the risk should be considered during surgical planning and abdominal access, especially in children ≤1 year old.
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Affiliation(s)
- Kelli N Patterson
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Tariku J Beyene
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Karen A Diefenbach
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
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Muacevic A, Adler JR, Draganov P, Bursian A, White JD. Gas Pressure From the Endoscope: An Unexplored Contributor to Morbidity and Mortality? Cureus 2022; 14:e31779. [PMID: 36569698 PMCID: PMC9774048 DOI: 10.7759/cureus.31779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background It has been shown that the incidence of venous air embolism and venous carbon dioxide (CO2) embolism is high during endoscopic retrograde cholangiopancreatography (ERCP). We examined insufflating gas flow and maximum pressure produced by three types of commonly used endoscopes because we could not readily locate technical data for endoscope gas flow and maximum emitted pressure in the manufacturer's manuals. Methods We tested the Olympus GIF-Q180 used for esophagogastroduodenoscopy, the CF-Q180 used for colonoscopy, and the TJF-Q180 used for ERCP (Olympus America Inc., Center Valley, Pennsylvania). Under three different clinical gas insufflation scenarios, we measured in vitro maximum gas pressure transduced from a closed space created at the endoscope tip in a worst-case scenario analysis. Results We showed that it is readily possible to generate a pressure (>5-30 times normal central venous pressure) in the air space at the tip of all three endoscopes when insufflation is activated and the gas egress is limited. Conclusions These findings shed additional light on in vivo occurrences of gas embolism during gastrointestinal endoscopy. We postulate that in addition to using exclusively CO2 as the insufflating gas, the risk of gas embolism can be further diminished by regulating insufflating gas pressure at the tip of endoscopes.
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Nakagawa R, Nohara T, Kadomoto S, Iwamoto H, Yaegashi H, Iijima M, Kawaguchi S, Shigehara K, Izumi K, Kadono Y, Mizokami A. Carbon dioxide gas embolism during robot‐assisted laparoscopic partial nephrectomy. IJU Case Rep 2022; 5:334-337. [PMID: 36090925 PMCID: PMC9436695 DOI: 10.1002/iju5.12472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/06/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction One of the complications of laparoscopic surgery is gas embolism, which has low incidence but high mortality. Carbon dioxide embolism diagnosed during robot‐assisted laparoscopic partial nephrectomy has been experienced. Case presentation 77‐year‐old woman with a left renal tumor received robot‐assisted laparoscopic partial nephrectomy. End‐tidal carbon dioxide pressure and oxygen saturation of peripheral artery suddenly decreased 5 min after the start of tumor resection with pneumoperitoneum pressure of 15 mmHg and positive end‐expiratory pressure turned off. Therefore, pulmonary artery gas embolism was diagnosed. The pneumoperitoneum pressure was dropped, and positive end‐expiratory pressure was restarted. These conditions improved and the procedure was completed. Conclusion Carbon dioxide gas embolism during robot‐assisted partial nephrectomy should be focused on because prompt diagnosis and treatment will improve life outcomes. The optimal pneumoperitoneum pressure for each case, rather than making it uniform, should be reconsidered.
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Affiliation(s)
- Ryunosuke Nakagawa
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Takahiro Nohara
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Suguru Kadomoto
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Hiroaki Iwamoto
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Hiroshi Yaegashi
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Masashi Iijima
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Shohei Kawaguchi
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
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Emir T, Denijal T. Systemic air embolism as a complication of gastroscopy. Oxf Med Case Reports 2019; 2019:omz057. [PMID: 31293787 PMCID: PMC6611497 DOI: 10.1093/omcr/omz057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 04/08/2019] [Accepted: 05/11/2019] [Indexed: 11/15/2022] Open
Abstract
Gastroscopy is a common medical procedure with a low complication rate. Most complications are related to respiratory or cardiovascular incidents, especially in sedated patients. Systemic air embolism secondary to gastroscopy is one of the most serious complications, which has been described in few case reports. We describe an interesting case of gastroscopy-related systemic air embolism in a 73-year-old patient.
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Affiliation(s)
- Tulumović Emir
- Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Ibre Pašića bb, Tuzla, Bosnia and Herzegovina
| | - Tulumović Denijal
- Department of Nephrology, Dialysis and Transplantation, University Clinical Center Tuzla, Ibre Pašića bb, Tuzla, Bosnia and Herzegovina
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Abstract
BACKGROUND Cerebral air embolism (CAE) is a rare but potentially devastating complication of endoscopic procedures. Only 3 cases, to our knowledge, have been reported. CASE PRESENTATION A 50-year-old female patient presented with hepatitis C virus-related hepatic cirrhosis, emergency endoscopy and endoscopic variceal ligation was performed in an awakened state. CAE occurred during procedure, the patient passed away the next day in the intensive care unit. CONCLUSIONS CAE is a rare but potentially devastating complication in endoscopic procedures. We need more preventive tools and treatments.
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8
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Cooper JS, Thomas J, Singh S, Brakke T. Endoscopic Bubble Trouble: Hyperbaric Oxygen Therapy for Cerebral Gas Embolism During Upper Endoscopy. J Clin Gastroenterol 2017; 51:e48-e51. [PMID: 27479145 DOI: 10.1097/mcg.0000000000000614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Gas embolism is a rare but potentially devastating complication of endoscopic procedures. We describe 3 cases of gas embolism which were associated with endoscopic procedures (esophagogastroduodenoscopy and endoscopic retrograde cholangiopancreatography). We treated these at our hyperbaric medicine center with 3 different outcomes: complete resolution, death, and disability. We review the literature regarding this unusual complication of endoscopy and discuss the need for prompt identification and referral for hyperbaric oxygen therapy. Additional adjunctive therapies are also discussed.
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Effects of carbon dioxide insufflation during direct cholangioscopy on biliary pressures and vital parameters: a pilot study in porcine models. Gastrointest Endosc 2017; 85:238-242.e1. [PMID: 27327853 DOI: 10.1016/j.gie.2016.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 06/02/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Direct per-oral cholangioscopy allows endoscopic visualization of the biliary tract. Insufflation with carbon dioxide (CO2) is an alternative to saline solution irrigation during direct cholangioscopy. There are no data on maximal CO2 insufflation in direct cholangioscopy without causing biliary barotrauma or fatal gas embolism. We aimed to evaluate the safety of increasing CO2 insufflation in direct cholangioscopy without causing biliary barotrauma or fatal gas embolism. METHODS This was an in vivo animal study. Four domestic pigs, under general endotracheal anesthesia, were used. The first animal was used to validate the feasibility of direct cholangioscopy and biliary pressure measurements, after which all animals underwent laparotomy, insertion of a pressure transducer in the cystic duct, and direct transpapillary placement of the cholangioscope. The common bile duct (CBD) and cystic duct were ligated to contain the instilled gas and exclusively expose the biliary tree. Insufflation of CO2 started at 200 mL/min and was continuously increased until there was evidence of bile duct rupture (as measured by a drop in intraductal pressures) or instability of vital signs (hypotension, bradycardia, bradypnea, O2 desaturation). Necropsy was performed on all animals to assess the liver and biliary system for evidence of barotrauma. RESULTS CO2 was insufflated up to 8 L/min without causing bile duct rupture or instability in vital signs despite increasing CBD pressure with insufflation. There was significant correlation between CO2 flow with partial pressure of CO2 in arterial blood (PaCO2) (coefficient, 0.96-1.00; P < .01) and end tidal expired CO2 (EtCO2) (coefficient, 0.94-1.00; P < .01). However, the pulse rate, respiratory rate, arterial blood pressure, and O2 did not correlate with the amount of CO2 flow. There was no evidence of hepatic or biliary barotrauma on necropsy. CONCLUSIONS This pilot experience in porcine models suggests that CO2 insufflation is safe for direct cholangioscopy and does not result in biliary barotrauma or vital signs instability.
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10
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Power NE, Silberstein JL, Tarin T, Au J, Thorner D, Ezell P, Monette S, Fong Y, Rusch V, Finley D, Coleman JA. Endoscopic spray cryotherapy for genitourinary malignancies: safety and efficacy in a porcine model. Ther Adv Urol 2013; 5:135-41. [PMID: 23730328 DOI: 10.1177/1756287212465457] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To examine the effects and safety of using endoscopic spray cryotherapy (ESC) on bladder, ureteral, and renal pelvis urothelium in a live porcine model. SUBJECTS AND METHODS ESC treatments were systematically applied to urothelial sites in the bladder, ureter, and renal pelvis of eight female Yorkshire swine in a prospective trial. Freeze-thaw cycles ranged from 5 to 60 s/cycle for one to six cycles using a 7 French cryotherapy catheter. Tissue was evaluated histologically for treatment-related effects. Acute physiologic effects were evaluated with pulse oximetry, Doppler sonography, and postmortem findings. RESULTS In bladder, treatment depth was inconsistent regardless of dose, demonstrating urothelial necrosis in one, muscularis propria depth necrosis in two, and full thickness necrosis in all remaining samples. In ureter, full thickness necrosis was seen in all samples, even with the shortest spray duration (5 s/cycle for six cycles or 30 s/cycle for one cycle). Treatment to the renal pelvis was complicated by adiabatic gas expansion of liquid nitrogen to its gaseous state, resulting in high intraluminal pressures requiring venting to avoid organ perforation, even at the lowest treatment settings. At a planned dose of 5 s/cycle for six cycles of the first renal pelvis animal, treatment was interrupted by sudden and unrecoverable cardiopulmonary failure after three cycles. Repeated studies replicated this event. Ultrasound and immediate necropsy confirmed the creation of a large gaseous embolism and reproducible cardiopulmonary effects. CONCLUSION ESC in a porcine urothelial treatment model results in full-thickness tissue necrosis in bladder, ureter, and renal pelvis at a minimal treatment settings of 5 s/cycle for six cycles. Adiabatic gas expansion may result in fatal pyelovenous gas embolism and collateral organ injury, as seen in both animals receiving treatment to the renal pelvis in this study. These results raise safety concerns for use of ESC as a treatment modality in urothelial tissues with current device settings.
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Affiliation(s)
- Nicholas E Power
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Traiki TB, Baaj J, Al Boukae A, Zubaidi A. Fatal air embolism during sigmoidoscopy performed under spinal anesthesia. Anesth Essays Res 2012; 6:210-2. [PMID: 25885620 PMCID: PMC4173453 DOI: 10.4103/0259-1162.108336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Air embolism is an uncommon but potentially catastrophic event that occurs when air enters the vasculature. Because of a scared and friable colorectal mucosa, patients with anastomotic stricture are at an increased risk of complications associated with sigmoidoscopy such as bowel perforation and bleeding. This is a report of fatal air embolism confirmed on an immediate postmortem chest radiograph in a patient with a high colorectal anastomotic stricture undergoing sigmoidoscopy under spinal anesthesia is reported. The literature on air embolism in patients undergoing sigmoidoscopy/colonoscopy is reviewed.
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Affiliation(s)
- Thamer Bin Traiki
- Department of Surgery, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jumana Baaj
- Department of Anesthesia, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Al Boukae
- Department of Radiology, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Zubaidi
- Department of Surgery, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract
Clinically significant carbon dioxide embolism is a rare but potentially fatal complication of anesthesia administered during laparoscopic surgery. Its most common cause is inadvertent injection of carbon dioxide into a large vein, artery or solid organ. This error usually occurs during or shortly after insufflation of carbon dioxide into the body cavity, but may result from direct intravascular insufflation of carbon dioxide during surgery. Clinical presentation of carbon dioxide embolism ranges from asymptomatic to neurologic injury, cardiovascular collapse or even death, which is dependent on the rate and volume of carbon dioxide entrapment and the patient's condition. We reviewed extensive literature regarding carbon dioxide embolism in detail and set out to describe the complication from background to treatment. We hope that the present work will improve our understanding of carbon dioxide embolism during laparoscopic surgery.
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Affiliation(s)
- Eun Young Park
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Ja-Young Kwon
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Jun Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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13
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Zald PB, Andersen PE. Fatal central venous air embolism: a rare complication of esophageal dilation by rendezvous. Head Neck 2011; 33:441-4. [PMID: 19953633 DOI: 10.1002/hed.21304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Esophageal dilation by rendezvous is a useful technique for the treatment of complicated esophageal strictures. METHODS AND RESULTS We present a case of a 74-year-old man with chronic dysphagia caused by a complete cervical esophageal stricture that developed after external beam radiotherapy for treatment of papillary thyroid carcinoma. During attempted dilation using the rendezvous technique, the patient suffered a fatal pulmonary air embolism. The technique of esophageal dilation by rendezvous, complications, and risk factors for development of venous air embolism are discussed. CONCLUSION To the best of our knowledge, this is the first report in the literature of fatal venous air embolism after dilation by rendezvous.
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Affiliation(s)
- Philip B Zald
- Department of Otolaryngology Head and Neck Surgery, Oregon Health and Sciences University, Portland, OR 97239, USA
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14
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Park YH, Kim HJ, Kim JT, Kim HS, Kim CS, Kim SD. Prolonged paradoxical air embolism during intraoperative intestinal endoscopy confirmed by transesophageal echocardiography -A case report-. Korean J Anesthesiol 2010; 58:560-4. [PMID: 20589182 PMCID: PMC2892591 DOI: 10.4097/kjae.2010.58.6.560] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 12/22/2009] [Accepted: 12/28/2009] [Indexed: 02/07/2023] Open
Abstract
Venous air embolism (VAE) during intestinal endoscopy is a rare complication. We report a case of cardiovascular collapse due to VAE confirmed by transesophageal echocardiography (TEE) during intraoperative intestinal endoscopy. TEE detected air bubbles in the left ventricle up to 1 hour after the event. When a patient deteriorates during endoscopic procedures, VAE and possible paradoxical air embolism (PAE) should be suspected. This case demonstrates that TEE can play an important role in diagnosing and managing an air embolism in anesthetized patients. In addition, this case demonstrates that PAEs may occur longer than expected after recovery from VAE-induced cardiovascular collapse.
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Affiliation(s)
- Yong Hee Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
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15
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Rangappa P, Uhde B, Byard RW, Wurm A, Thomas PD. Fatal cerebral arterial gas embolism after endoscopic retrograde cholangiopancreatography. Indian J Crit Care Med 2010; 13:108-12. [PMID: 19881196 PMCID: PMC2772239 DOI: 10.4103/0972-5229.56061] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We report the case of a 50-year-old woman undergoing elective endoscopic retrograde cholangiopancreatography, who developed coma and hemiparesis secondary to severe cerebral artery gas embolism. Despite prompt diagnosis and early hyperbaric oxygen therapy (HBO2) she developed severe cerebral edema and died within 24 h.
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Affiliation(s)
- Pradeep Rangappa
- Columbia Asia Referral Hospital, Yeshwantpur, Bangalore - 560 055, India.
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16
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Mal F, Choury AD, De Castro V, Christidis C, Carbognani D, Validire P, Gayet B. [Fatal venous air embolism during biliary endoscopy]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2010; 34:e17-e18. [PMID: 20171031 DOI: 10.1016/j.gcb.2009.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 11/12/2009] [Accepted: 12/15/2009] [Indexed: 05/28/2023]
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17
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Fatal systemic venous air embolism during endoscopic retrograde cholangiopancreatography. Adv Anat Pathol 2009; 16:255-62. [PMID: 19546613 DOI: 10.1097/pap.0b013e3181aab793] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hepatic portal venous air embolism is the rarest complication of gastrointestinal endoscopy, resulting from penetration of gas into the portal veins, and may occur during endoscopic retrograde cholangiopancreatography and endoscopic biliary sphincterotomy. The likely mechanism is intramural dissection of insufflated air into the portal venous system through duodenal vein radicles transected during the procedure. Hepatic portal air embolism may be fatal. Cerebral air embolism may also occur. So far 13 cases of air embolism after endoscopic retrograde cholangiopancreatography have been reported, with 4 cases of systemic spread that proved fatal. Death was due to pulmonary air embolism in 2 cases, and cerebral air embolism in another 2. We report on an additional such fatal case, concerning a 78-year-old male patient, who several years previously had undergone surgical gastroduodenal resection with cholecystectomy and papillotomy, and was admitted for recurrent ascending cholangitis secondary to bile duct stones. During the third endoscopic cholangioscopic procedure for removal of bile duct stones, sudden cardiopulmonary arrest occurred. Death was due to massive pulmonary air embolism. Cerebral air embolism was also found. Autopsy was performed. A spontaneous duodenobiliary fistula was found. On the basis of bench radiologic investigation (retrograde suprahepatic venography and anterograde portography), it was demonstrated that the air insufflated during duodenal endoscopy, which entered through the spontaneous duodeno-biliary fistula, penetrated into intrahepatic vein radicles injured secondarily to prolonged impaction of biliary sand and stones and infection, resulting in portal and hepatic venous gas and systemic air embolism.
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Ha JF, Allanson E, Chandraratna H. Air embolism in gastroscopy. Int J Surg 2009; 7:428-30. [DOI: 10.1016/j.ijsu.2009.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 08/07/2009] [Indexed: 12/21/2022]
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Jørgensen TB, Sørensen AM, Jansen EC. Iatrogenic systemic air embolism treated with hyperbaric oxygen therapy. Acta Anaesthesiol Scand 2008; 52:566-8. [PMID: 18339163 DOI: 10.1111/j.1399-6576.2008.01598.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Air embolism is a rare and potentially severe complication of surgical and invasive procedures. Emboli large enough to produce symptoms require immediate treatment because of the risk of 'gas lock' in the right side of the heart and subsequent circulatory failure. If air is transmitted to the arterial circulation through a shunt, it may cause cerebral emboli with neurological symptoms. We present two cases with venous air emboli and concurrent cerebral arterial emboli. Both patients were successfully treated with hyperbaric oxygen therapy.
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Affiliation(s)
- T B Jørgensen
- Department of Anaesthesia, Abdominal Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
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Sellner F, Sobhian B, Baur M, Sellner S, Horvath B, Mostegel M, Karner J, Staettner S. Intermittent hepatic portal vein gas complicating diverticulitis--a case report and literature review. Int J Colorectal Dis 2007; 22:1395-9. [PMID: 17637998 DOI: 10.1007/s00384-007-0346-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2007] [Indexed: 02/04/2023]
Abstract
CASE REPORT This report describes a case of intermittent hepatic portal venous gas (HPVG) because of colonic diverticulitis in a 48-year-old man, who was successfully treated by surgery. CONCLUSION Based on an extensive literature search, which produced 21 observations, the etiology, symptoms, imaging features, clinical significance, treatment strategy, and outcome of HPVG because of colonic diverticulitis are evaluated: While observations with an underlying intramesocolic abscess carry a favorable prognosis, the prognosis of observations because of septic thrombophlebitis with gas forming germs is poor.
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Affiliation(s)
- Franz Sellner
- Department of Surgery, Kaiser Franz Josef Hospital, Chirurgische Abteilung, Kundratstr. 3, 1100, Vienna, Austria.
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Sudden cardiovascular collapse caused by carbon dioxide embolism during endoscopic saphenectomy for coronary artery bypass grafting. Chin Med J (Engl) 2006. [DOI: 10.1097/00029330-200602020-00015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Nayagam J, Ho KM, Liang J. Fatal systemic air embolism during endoscopic retrograde cholangio-pancreatography. Anaesth Intensive Care 2005; 32:260-4. [PMID: 15957727 DOI: 10.1177/0310057x0403200217] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Air embolism is a rare complication of gastrointestinal endoscopy. We present a 56-year-old male who developed both venous and systemic arterial air embolism during an endoscopic retrograde cholangiopancreatogram. Despite early treatment based on clinical diagnosis and confirmation by transthoracic echocardiography, the patient died as a result of severe cerebral ischaemia. Risk factors associated with air embolism in gastrointestinal endoscopic procedures include situations where the mucosa is not intact or where high pressures are generated in the lumen of the gastrointestinal tract. Clinical diagnosis of air embolism during endoscopy is difficult and urgent echocardiography is the investigation of choice. Treatment is largely supportive but hyperbaric oxygen therapy should be considered in any severe cases, especially if neurological injury is present.
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Affiliation(s)
- J Nayagam
- Department of Anaesthesia and Intensive Care, North Shore hospital, Auckland, New Zealand
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Affiliation(s)
- Bryan T Green
- Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA
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Lin TY, Chiu KM, Wang MJ, Chu SH. Carbon dioxide embolism during endoscopic saphenous vein harvesting in coronary artery bypass surgery. J Thorac Cardiovasc Surg 2004; 126:2011-5. [PMID: 14688720 DOI: 10.1016/s0022-5223(03)01323-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Our objectives were to determine the incidence and severity and the time course of the CO(2) embolism during endoscopic saphenous vein harvesting with CO(2) insufflation in coronary artery bypass surgery with transesophageal echocardiography monitoring. METHODS Four hundred three consecutive patients scheduled for off-pump coronary artery bypass grafting surgery or femoral-to-popliteal artery bypass grafting surgery were prospectively studied. Multiplane transesophageal echocardiography with a new transgastric view was used to monitor CO(2) bubbles in the inferior vena cava and hepatic vein. RESULTS CO(2) embolisms occurred in 17.1% of patients. Minimal, moderate, and massive CO(2) embolisms occurred in 13.1%, 3.5%, and 0.5%, respectively. The occurrence of moderate and massive CO(2) embolisms was frequently associated with the surgical manipulation of branches of saphenous veins. No significant risk factors were identified in multiple logistic regression analysis. CONCLUSION The incidence of significant CO(2) embolism during endoscopic saphenous vein harvesting with CO(2) insufflation procedures was more than 4%. Continuous transesophageal echocardiographic monitoring of the CO(2) bubbles in the inferior vena cava is essential in early detection and can help to prevent the development of significant CO(2) embolisms in these patients.
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Affiliation(s)
- Tzu-Yu Lin
- Department of Anesthesia, Far Eastern Memorial Hospital, Taiwan
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Takeuchi Y, Yoshikawa M, Shirahama K, Tsukamoto N, Shiroi A, Uchida Y, Miyawaki S, Yamada S, Kikuchi E, Fukui H, Ishii M. Cerebral artery air embolism during endoscopic variceal ligation: case report. Gastrointest Endosc 2004; 59:123-5. [PMID: 14722566 DOI: 10.1016/s0016-5107(03)02358-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Yoji Takeuchi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Bellland General Hospital, Sakai, Osaka, Japan
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Martineau A, Arcand G, Couture P, Babin D, Perreault LP, Denault A. Transesophageal echocardiographic diagnosis of carbon dioxide embolism during minimally invasive saphenous vein harvesting and treatment with inhaled epoprostenol. Anesth Analg 2003; 96:962-964. [PMID: 12651642 DOI: 10.1213/01.ane.0000048827.03602.3f] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPLICATIONS We describe a patient scheduled for coronary artery bypass who developed carbon dioxide (CO2) embolism with acute pulmonary hypertension during endoscopic saphenectomy. Transesophageal echocardiography was useful in the diagnosis of CO2 embolism and to assess response to inhaled epoprostenol.
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Affiliation(s)
- André Martineau
- Departments of *Anesthesiology and †Surgery, Montreal Heart Institute, Quebec, Canada
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Abstract
BACKGROUND Although most gastrointestinal endoscopic procedures are performed by gastroenterologists, surgeons often assist in the management of patients with complications. This review provides an introduction to the incidence, prevention, and treatment of complications that may occur after upper endoscopy, colonoscopy, percutaneous endoscopic gastrostomy, and endoscopic retrograde cholangiopancreatography. METHODS Systematic review of the literature. RESULTS Preprocedural complications include medication effects and adverse effects of bowel preparation. Major procedural complications consist primarily of perforation and hemorrhage. Percutaneous endoscopic gastrostomy tube placement may be complicated by fistula and obstruction. There is also a risk of infectious disease transmission, both to and from the patient. CONCLUSIONS Endoscopy, like all invasive procedures, carries significant potential risks for the patient. In practiced hands, and with awareness of the problems that may arise, many complications may be avoided and others successfully managed.
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Affiliation(s)
- S M Kavic
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Chavanon O, Tremblay I, Delay D, Bouveret A, Blain R, Perrault LP. Carbon dioxide embolism during endoscopic saphenectomy for coronary artery bypass surgery. J Thorac Cardiovasc Surg 1999; 118:557-8. [PMID: 10469975 DOI: 10.1016/s0022-5223(99)70196-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- O Chavanon
- Department of Surgery, Montreal Heart Institute, Quebec, Canada
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