Olaiya Babatunde, Adler Douglas G
Department of Internal Medicine, Marshfield Clinic, Marshfield WI (Babatunde Olaiya).
Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah (Douglas G. Adler), USA.
Ann Gastroenterol. 2019 Sep-Oct;32(5):476-481. doi: 10.20524/aog.2019.0401. Epub 2019 Jul 17.
Air embolism is a rare, but potentially catastrophic complication of endoscopic procedures. We herein evaluated the overall incidence of air embolism after endoscopy. We also measured mortality outcomes after air embolism.
Patients who underwent endoscopy as an index procedure during hospitalization were selected from the National Inpatient Sample from 1998-2013. The primary outcome of interest was the incidence of air embolism after endoscopy. All-cause mortality after endoscopy was measured as a secondary outcome and the Charlson Comorbidity Index was calculated. Binary logistic regression was used to explore the effect of air embolism on inpatient mortality, using P<0.05 as level of significance.
A total of 2,245,291 patients met the inclusion criteria. Mean age at the time of procedure was 62.5 years. Esophagogastroduodenoscopy (EGD) was the most common endoscopic procedure, accounting for 80% of endoscopic procedures. Air embolism occurred in 13 cases, giving a rate of 0.57 per 100,000 endoscopic procedures. Air embolism was most common after endoscopic retrograde cholangiopancreatography (ERCP), occurring in 3.32 per 100,000 procedures, compared with 0.44 and 0.38 per 100,000 procedures for EGD and colonoscopy, respectively. The case fatality rate for post endoscopic air embolism was 15.4%. After adjusting for covariates, air embolism after endoscopy was independently associated with higher odds of inpatient mortality: odds ratio 10.35, 95% confidence interval 1.21-88.03 (P<0.03).
Air embolism is most common after ERCP. It is frequently associated with disorders involving a breach to the gastrointestinal mucosa or vasculature. Though rare, it is an independent predictor of inpatient mortality.
空气栓塞是一种罕见但可能具有灾难性的内镜手术并发症。我们在此评估了内镜检查后空气栓塞的总体发生率。我们还测量了空气栓塞后的死亡率。
从1998年至2013年的国家住院样本中选取住院期间接受内镜检查作为索引手术的患者。感兴趣的主要结局是内镜检查后空气栓塞的发生率。测量内镜检查后的全因死亡率作为次要结局，并计算Charlson合并症指数。采用二元逻辑回归探讨空气栓塞对住院患者死亡率的影响，以P<0.05为显著性水平。
共有2245291例患者符合纳入标准。手术时的平均年龄为62.5岁。食管胃十二指肠镜检查（EGD）是最常见的内镜手术，占内镜手术的80%。空气栓塞发生13例，每100000例内镜手术发生率为0.57例。空气栓塞在内镜逆行胰胆管造影（ERCP）后最为常见，每100000例手术发生率为3.32例，而EGD和结肠镜检查每100000例手术发生率分别为0.44例和0.38例。内镜后空气栓塞的病死率为15.4%。调整协变量后，内镜检查后空气栓塞与住院患者死亡几率较高独立相关：比值比为10.35，95%置信区间为1.21-88.03（P<0.03）。
空气栓塞在ERCP后最为常见。它常与涉及胃肠道黏膜或血管破裂的疾病相关。虽然罕见，但它是住院患者死亡率的独立预测因素。
