Journal article
Cerebral Air Embolism after Esophagogastroduodenoscopy: Insight on Pathophysiology, Epidemiology, Prevention and Treatment
Journal of stroke and cerebrovascular diseases, Vol.28(12), 104403
12/2019
DOI: 10.1016/j.jstrokecerebrovasdis.2019.104403
PMID: 31563566
Abstract
Air embolism is an extremely rare complication that can follow gastrointestinal endoscopy. The most accepted treatment of cerebral air embolism (CAE) is hyperbaric oxygen (HBO). Limited evidence suggests that lidocaine may have a neuroprotective effect. The exact mechanism does not appear to be well elucidated.
We conducted a literature search using multiple combinations of keywords from PubMed and Ovid Medline databases according to the PRISMA guidelines. We included articles with cases of air embolism caused by an esophagogastroduodenoscopy (EGD). We excluded cases related to other procedures e.g. colonoscopy, endoscopic retrograde cholangiopancreatography, cholangioscopy, Kasai procedure, bronchoscopy, laparoscopy or thoracoscopy. We were able to identify 30 cases of CAE associated with EGD. We included our experience in treating one patient with CAE after elective EGD.
Given the results of our literature search and this patient's characteristics, we chose to treat our patient with HBO and lidocaine infusion. Our case series consists of 31 patients of post EGD CAE, the mean age was 63.7 ± 11.14 years, 38.7% of the patients were women (n = 12). 38.7% of the cases underwent esophageal dilatation (n = 12), while 19.35% had EGD biopsy (n = 6), 9.6% had variceal ligation (n = 3), and 3.22% had variceal banding (n = 1). In 20 out of 31 cases, echocardiography has been documented, 20% of those patients (n = 4) had patent foramen ovale. HBO was used in treatment of 48% of cases (n = 15), among the included patients, 61% survived (n = 19). Our patient showed significant neurological improvement.
Despite the rare incidence of CAE during or after EGD, physicians should be aware of this potential complication. In patients who develop sudden acute neurological symptoms, early diagnosis and intervention may prevent devastating neurological injury and death. The most accepted emergent treatment for CAE includes HBO, consideration of lidocaine, and work-up of source of the air embolism.
Details
- Title: Subtitle
- Cerebral Air Embolism after Esophagogastroduodenoscopy: Insight on Pathophysiology, Epidemiology, Prevention and Treatment
- Creators
- Malik Ghannam - University of MinnesotaAzizullah Beran - Mayo ClinicDana Ghazaleh - University of Minnesota SystemTanner Ferderer - University of MinnesotaBrent Berry - University of MinnesotaMona Al Banna - University of MinnesotaLeighton Mohl - University of MinnesotaChristopher Streib - University of MinnesotaTapan Thacker - Hennepin County Medical CenterIvan Matos - Hennepin County Medical Center
- Resource Type
- Journal article
- Publication Details
- Journal of stroke and cerebrovascular diseases, Vol.28(12), 104403
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jstrokecerebrovasdis.2019.104403
- PMID
- 31563566
- ISSN
- 1052-3057
- eISSN
- 1532-8511
- Language
- English
- Date published
- 12/2019
- Academic Unit
- Neurology
- Record Identifier
- 9984585319902771
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