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World J Gastrointest Endosc. Aug 16, 2013; 5(8): 359-365
Published online Aug 16, 2013. doi: 10.4253/wjge.v5.i8.359
Air embolism complicating gastrointestinal endoscopy: A systematic review
Suman Donepudi, Disaya Chavalitdhamrong, Liping Pu, Peter V Draganov
Suman Donepudi, Disaya Chavalitdhamrong, Liping Pu, Peter V Draganov, Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Florida, Gainesville, FL 32610, United States
Liping Pu, Department of Medicine and Nursing, Suzhou Health College, Suzhou 215009, Jiangsu Province, China
Author contributions: Donepudi S and Chavalitdhamrong D performed the literature review and drafted the manuscript; Pu L performed the literature review; Draganov PV performed critical revision of the manuscript for all intellectual contents.
Correspondence to: Peter V Draganov, MD, Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Florida, Room HD 602, PO Box 100214, Gainesville, FL 32610, United States. dragapv@medicine.ufl.edu
Telephone: +1-352-2739474 Fax: +1-352-3923618
Received: May 29, 2013
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.

Keywords: Air embolism, Endoscopy, Endoscopic retrograde cholangiopancreatography, Complications, Therapy

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.