[Gas embolism during endoscopic procedures]

Endoscopic retrograde cholangiopancreatography (ERCP) is associated with gas embolism, which is often fatal when observed through clinical signs. Here we report the only case, to our knowledge, of a survivor of paradoxal gas embolism with a patent foramen ovale during ERCP. The patient suffered respiratory collapse with unmeasurable end-tidal carbon dioxide and severe hypoxemia. Total circulatory collapse was imminent, as demonstrated by severe hypotension and bradycardia with prominent S-T depressions on ECG. Transesophageal echocardiography (TEE) showed massive amounts of biventricular gas bubbles and a patent foramen ovale. After resuscitation with epinephrine, norepinephrine, crystalloid fluid boluses and a 100% fraction of inspired oxygen the patient's condition improved, and he was transferred to the intensive care unit. Repeat TEE showed that the gas bubbles had disappeared, and the patient was extubated that same evening. No neurological deficits were found before discharge. We want to highlight the importance of keeping gas embolism in mind when performing endoscopic procedures.