Published online Aug 16, 2013. doi: 10.4253/wjge.v5.i8.359
Revised: July 12, 2013
Accepted: July 17, 2013
Published online: August 16, 2013
Gastrointestinal endoscopy has become an important modality for the diagnosis and treatment of various gastrointestinal disorders. One of its major advantages is that it is minimally invasive and has an excellent safety record. Nevertheless, some complications do occur, and endoscopists are well aware and prepared to deal with the commonly recognized ones including bleeding, perforation, infection, and adverse effects from the sedative medications. Air embolism is a very rare endoscopic complication but possesses the potential to be severe and fatal. It can present with cardiopulmonary instability and neurologic symptoms. The diagnosis may be difficult because of its clinical presentation, which can overlap with sedation-related cardiopulmonary problems or neurologic symptoms possibly attributed to an ischemic or hemorrhagic central nervous system event. Increased awareness is essential for prompt recognition of the air embolism, which can allow potentially life-saving therapy to be provided. Therefore, we wanted to review the risk factors, the clinical presentation, and the therapy of an air embolism from the perspective of the practicing endoscopist.
Core tip: Air embolism at the time of endoscopy can cause cardiovascular, pulmonary, and neurologi cal symptoms. Symptom onset during the position change from prone to supine is characteristic and should trigger immediate suspicion for air embolism. Potentially lifesaving therapeutic measures should be promptly initiated, including placing the patient in Trendelenburg and left lateral decubitus position, high-flow oxygen, volume expansion and urgent hyperbaric oxygenation therapy.