Cerebral air embolism following an endoscopic variceal ligation

Bai, Xuesong; Yang, Bo; Liu, Hong-Lan; Yin, Zi

doi:10.1097/md.0000000000010965

Cited by 3 publications

(4 citation statements)

References 23 publications

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“…Iatrogenic air emboli during endoscopic procedures are rare, difficult to diagnose, and have a high potential for being severe and fatal. An air embolism develops when air is introduced into the vascular system and can be facilitated with a pressurized air source [ 3 , 4 ]. A disruption of the mucosal barrier is commonly associated in such cases [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…A disruption of the mucosal barrier is commonly associated in such cases [ 2 ]. Prompt recognition of neurologic symptoms after an endoscopic procedure is imperative to reduce mortality [ 1 – 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…The patient died 1 day later in the intensive care unit. Although this patient did not receive hyperbaric oxygen therapy, the case highlights the possible impact in fatality rate due to underlying comorbidities [ 2 , 3 ].…”

Section: Discussionmentioning

confidence: 99%

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Iatrogenic Cerebral Air Embolism During Esophago-Gastroduodenoscopy

et al. 2020

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Patient: Male, 72-year-old Final Diagnosis: Air embolism • stroke Symptoms: Altered mental status Medication:— Clinical Procedure: Endoscopy • esophagogastroduodenoscopy • hyperbaric oxygen treatment • variceal banding Specialty: Neurology • Radiology Objective: Rare disease Background: Cerebral air embolism is a rare iatrogenic complication of endoscopic procedures that can result in irreversible neurological damage. The symptoms of cerebral air embolism are nonspecific and may be attributed to sedation-related complications and central nervous system insults. Having awareness of this rare iatrogenic event and deciding on immediate imaging when it is suspected are essential for prompt diagnosis and treatment. Case Report: A 72-year-old man with a past medical history of alcoholic liver cirrhosis with associated portal hypertension underwent an outpatient esophago-gastroduodenoscopy for surveillance of esophageal varices. During the procedure, the patient retched several times and developed a mucosal tear, which was repaired using endoscopic clips. After the procedure, the patient remained sedated for a prolonged time and was subsequently unresponsive. Nonenhanced CT of the head showed several foci of gas throughout the subarachnoid spaces. Follow-up nonenhanced brain magnetic resonance imaging demonstrated ischemic changes, which were more prominent along the right cerebral hemisphere. Conclusions: Cerebral air embolism is an iatrogenic complication of endoscopic procedures that can result in irreversible neurological damage. It must be included in the differential diagnosis of a patient presenting with altered mental status and neurological deficits after an endoscopic procedure. Diagnostic imaging can be useful in identifying key features of this iatrogenic event. Timely diagnosis and treatment can improve patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Iatrogenic Cerebral Air Embolism During Esophago-Gastroduodenoscopy

et al. 2020

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“…However, these treatments are not without potentially serious complications. EVL, which can cause cerebral air embolism[ 4 ] and infective endocarditis[ 5 ], has not been widely used in gastric varices. EIS has a high complication rate for gastric ulceration, perforation, and rebleeding (37%-53%)[ 3 , 6 ], and its sclerosing agent can leak into the inferior vena cava[ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic clipping for the secondary prophylaxis of bleeding gastric varices in a patient with cirrhosis: A case report

Yang¹,

Mo²,

Zhang³

et al. 2022

WJCC

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BACKGROUND Bleeding from gastroesophageal varices (GOV) is a serious complication in patients with liver cirrhosis, carrying a very high mortality rate. For secondary prophylaxis against initial and recurrent bleeding, endoscopic therapy is a critical intervention. Endoscopic variceal clipping for secondary prophylaxis in adult GOV has not been reported. CASE SUMMARY A 66-year-old man with cirrhosis was admitted to our hospital complaining of asthenia and hematochezia for 1 wk. His hemoglobin level and red blood cell counts were significantly decreased, and his fecal occult blood test was positive. An enhanced computed tomography of the abdomen showed GOV. The patient was diagnosed with hepatitis B cirrhosis-related GOV bleeding. A series of palliative treatments were administered, resulting in significant clinical improvement. Subsequently, an endoscopic examination revealed severe gastric fundal varices, prompting endoscopic variceal clipping. There were no further episodes of gastrointestinal bleeding. The GOV improved significantly on follow-up imaging and was confirmed as improved on endoscopy at the 5 th postoperative month. CONCLUSION Our results suggest that endoscopic clipping is an inexpensive, safe, easy, effective, and tolerable method for the secondary prophylaxis of bleeding from gastric type 2 GOV. However, additional research is indicated to confirm its long-term safety and efficacy.

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