Acute pulmonary embolism following endoscopic sclerotherapy for gastroesophageal variceal hemorrhage: A case report and literature review

Tangcheewinsirikul, Nuanrat; Suankratay, Chusana

doi:10.1177/2050313x19838946

Cited by 5 publications

(7 citation statements)

References 11 publications

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“…To our knowledge, most cases of glue migration have been described in gastroenterology after endoscopic interventions (9)(10)(11)(12), and only one case has been reported after embolization of pelvic varices (13) Previous case reports reported a wide spectrum of symptoms ranging from the absence of symptoms to life-threatening conditions. A retrospective study identi ed an incidence of 4.3% of NTPE after glue embolization (14), with an increased risk when the injection exceeds a volume of 4.2 mL.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary glue embolism after radiological embolization of pelvic varices: A case report.

Longueville,

Dury,

Ancel

et al. 2024

Preprint

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Background: Non-thrombotic pulmonary embolism (NTPE) is defined as embolization in the pulmonary circulation of biological or non-biological substances and foreign bodies. The migration of glue in the pulmonary circulation during interventional procedures is unusual and has been reported mainly after gastroenterological procedures. The most severe cases of NTPE can be life-threatening. Case presentation: A 31-year-old woman developed respiratory failure 24 hours after radiological embolization of pelvic varices. Glue embolization was detected during the intervention and was confirmed on a chest CT scan showing multiple bilateral hyperdense elements up to sub-pleural regions. The patient developed respiratory symptoms 24 hours after the procedure, progressively worsening with oxygen requirement up to 6 L/min. A follow-up chest CT angiography showed a thrombotic pulmonary embolism. Treatments included curative anticoagulation, antibiotherapy, corticosteroids, and oxygen, leading to improvement after 10 days of treatment. Conclusions: This case report highlights that NTPE can occur after all interventional procedures using glue including pelvic procedures and can be complicated by thrombotic pulmonary embolism.

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Section: Discussionmentioning

confidence: 99%

Pulmonary glue embolism after radiological embolization of pelvic varices: A case report.

Longueville,

Dury,

Ancel

et al. 2024

Preprint

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“…[ 4 ] In the case of a patent foramen oval , the emboli might travel into the systemic circulation and cause distant organ embolization specifically in the cerebral and coronary circulation. [ 5 6 ]…”

Section: Discussionmentioning

confidence: 99%

“…The timing is also highly variable, ranging from a few minutes to days after the injection. [ 6 9 10 ] Pulmonary edema and chemical acute respiratory distress syndrome can also be a manifestation of this entity. [ 9 10 ]…”

Section: Discussionmentioning

confidence: 99%

Pulmonary biological glue embolism after endoscopic repair of gastric varices – A case report

Penedos

Pereira

Lemos

et al. 2023

Saudi Journal of Anaesthesia

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Cyanoacrylate injection is widely used to treat hemorrhagic gastric varices. A pulmonary glue embolism is an unusual but potentially fatal complication. We present a case of a 51-year-old man with a history of alcoholic hepatic cirrhosis Child-Pugh B, who had an acute pulmonary embolism with sudden cardiorespiratory collapse due to biological glue injection used for the emergent repair of bleeding gastric varices. After the restoration of respiratory and hemodynamic parameters, he was admitted to the intensive care unit and the pulmonary biological glue emboli were documented with computed tomography scan. A high index of suspicion for this entity is essential in patients submitted to endoscopic sclerotherapy. Some might be asymptomatic or mildly symptomatic, while others might present with cardiorespiratory collapse.

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“…Complications associated with NB2CYA injection include venous and arterial embolism, including pulmonary thromboembolism or stroke, splenic and portal vein thrombosis, esophageal perforation, and sepsis [ 2 , 3 , 5 , 6 ]. A retrospective review identified a risk of embolization associated with the injection of NB2CYA between 0.5% and 4.3% [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…The pathophysiology of pulmonary embolism associated with NB2CYA injection seems to be associated with a portosystemic high-flow vascular shunt, particularly a gastrosplenorenal shunt that reopens from embryonic vascular pathways, which also occurs in portal hypertension [ 3 - 5 ]. These portosystemic shunts may serve as a shortcut for NB2CYA embolization, which reinforces the need for angiographic studies prior to endoscopic intervention [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Embolization After Gastric Varices Obliteration

Duarte,

Lopes,

Trovão Bastos

et al. 2023

Cureus

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N-butyl-2-cyanoacrylate (NB2CYA) is frequently used in the treatment of variceal hemorrhage with a success rate in hemostatic control of 87%-100%. Although rare, complications include esophageal perforation, infection, or arterial and venous embolization. We present the case of a 67-year-old male with chronic ethanolic liver disease hospitalized due to melena and hematemesis. He had anemia requiring transfusion support, octreotide, and pantoprazole infusion. Upper digestive endoscopy was performed showing gastric varices with a hemorrhagic rupture point treated with cyanoacrylate. The patient developed respiratory failure over the next 48 hours with chest computed tomography (CT) angiography showing several dense, scattered linear images, with arterial vascular trajectories suggestive of cyanoacrylate embolization. It was decided to provide ventilatory support with invasive mechanical ventilation, initiate systemic corticosteroid therapy, and transfer the patient to the intensive care unit (ICU). The patient was ventilated for 11 days with initial favorable evolution, but after two episodes of decompensation of his chronic liver disease (CLD) (hepatic encephalopathy and hepatorenal syndrome) and a new nosocomial pneumonia, he ended up dying. The present case illustrates a rare but potentially fatal complication associated with cyanoacrylate, highlighting the importance of a high suspicion index in cases of respiratory failure and dyspnea after this therapy.

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Acute pulmonary embolism following endoscopic sclerotherapy for gastroesophageal variceal hemorrhage: A case report and literature review

Cited by 5 publications

References 11 publications

Pulmonary glue embolism after radiological embolization of pelvic varices: A case report.

Pulmonary glue embolism after radiological embolization of pelvic varices: A case report.

Pulmonary biological glue embolism after endoscopic repair of gastric varices – A case report

Pulmonary Embolization After Gastric Varices Obliteration

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