Endoscopists and anesthesiologists must remain vigilant during ERCP for uncommon but potentially devastating complications such as VAE. Insufflation with CO2 clearly mitigates this risk, and concurrently reduces postoperative abdominal pain, distension, and overall complications. Moreover, it is increasingly recognized that even “small air bubbles” do matter, and anesthesia providers should institute practices to minimize the embolic gas load to all patients.
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