Iatrogenic Arterial Gas Embolism From Esophagogastroduodenoscopy

Arterial gas embolus (AGE) is a rare complication of esophagoduodenoscopy (EGD) that has been described in only a few case reports in the literature. The exact etiology remains unknown, but many of the cases share some common characteristics.

We report the case of a 52-year-old otherwise healthy man who underwent outpatient EGD for a sensation of retained food in his esophagus. During the procedure, he suffered a tonic-clonic seizure, bradycardia, and hypoxia. Subsequent emergency department workup showed pneumocephalus on computed tomography brain imaging, and he was diagnosed with a cerebral AGE (CAGE). He was transferred to our facility for treatment of CAGE with hyperbaric oxygen therapy (HBOT). After multiple hyperbaric treatments, he was discharged with a residual left hemiparesis, which represented a significant improvement in his overall neurologic status. We also present a review of similar EGD CAGE cases from the literature and discuss their outcomes and the need for HBOT. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although CAGE from EGD is rare, these patients will often be transferred to the ED from gastrointestinal procedural suites and an emergency physician should understand that an iatrogenic CAGE can result from this procedure and that CAGE is a clinical diagnosis. Definitive care at a critical care-capable hyperbaric chamber will provide the patient with the best chance of meaningful recovery, and transport should be arranged as expeditiously as possible.