Cerebral Air Embolism after Esophagogastroduodenoscopy: Insight on Pathophysiology, Epidemiology, Prevention and Treatment

Malik Ghannam, Azizullah Beran, Dana Ghazaleh, Tanner Ferderer, Brent Berry, Mona Al Banna, Leighton Mohl, Christopher Streib, Tapan Thacker, Ivan Matos

Research output: Contribution to journalArticle

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Article number104403
JournalJournal of Stroke and Cerebrovascular Diseases
Volume28
Issue number12
DOIs
StatePublished - Dec 2019

Fingerprint

Digestive System Endoscopy
Intracranial Embolism
Air Embolism
Epidemiology
Lidocaine
Oxygen
Therapeutics
Patent Foramen Ovale
Thoracoscopy
Gastrointestinal Endoscopy
Endoscopic Retrograde Cholangiopancreatography
Bronchoscopy
Neuroprotective Agents
Colonoscopy
PubMed
Laparoscopy
Ligation
Echocardiography
Early Diagnosis
Dilatation

Keywords

  • Cerebral air embolism
  • epidemiology
  • esophagogastroduodenoscopy
  • pathophysiology
  • prevention
  • treatment

PubMed: MeSH publication types

  • Case Reports
  • Journal Article
  • Systematic Review

Cite this

Cerebral Air Embolism after Esophagogastroduodenoscopy : Insight on Pathophysiology, Epidemiology, Prevention and Treatment. / Ghannam, Malik; Beran, Azizullah; Ghazaleh, Dana; Ferderer, Tanner; Berry, Brent; Banna, Mona Al; Mohl, Leighton; Streib, Christopher; Thacker, Tapan; Matos, Ivan.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 28, No. 12, 104403, 12.2019.

Research output: Contribution to journalArticle

Ghannam, Malik ; Beran, Azizullah ; Ghazaleh, Dana ; Ferderer, Tanner ; Berry, Brent ; Banna, Mona Al ; Mohl, Leighton ; Streib, Christopher ; Thacker, Tapan ; Matos, Ivan. / Cerebral Air Embolism after Esophagogastroduodenoscopy : Insight on Pathophysiology, Epidemiology, Prevention and Treatment. In: Journal of Stroke and Cerebrovascular Diseases. 2019 ; Vol. 28, No. 12.
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abstract = "Background: 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. Methods: 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. Results: 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. Conclusions: 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.",
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T2 - Insight on Pathophysiology, Epidemiology, Prevention and Treatment

AU - Ghannam, Malik

AU - Beran, Azizullah

AU - Ghazaleh, Dana

AU - Ferderer, Tanner

AU - Berry, Brent

AU - Banna, Mona Al

AU - Mohl, Leighton

AU - Streib, Christopher

AU - Thacker, Tapan

AU - Matos, Ivan

PY - 2019/12

Y1 - 2019/12

N2 - Background: 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. Methods: 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. Results: 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. Conclusions: 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.

AB - Background: 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. Methods: 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. Results: 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. Conclusions: 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.

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KW - epidemiology

KW - esophagogastroduodenoscopy

KW - pathophysiology

KW - prevention

KW - treatment

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