Gastroenterol Res
Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website


Volume 12, Number 6, December 2019, pages 283-287

Clinical Presentation, Diagnosis, and Management of Air Embolism During Endoscopic Retrograde Cholangiopancreatography

Muhammad Haisum Maqsooda, f, Nayab Mirzaa, Muhammad Asad Hanifa, Hira Hanifb, Maleeha Saleemc, Muhammad Arqam Maqsoodd, Ilsa Fatimae, Muhammad Moiz Tahira

aInternal Medicine, King Edward Medical University, Lahore, Pakistan
bInternal Medicine, Allama Iqbal Medical College, Lahore, Pakistan
cDoctors Hospital, Lahore, Pakistan
dLahore Medical College, CMH, Lahore, Pakistan
eServices Institute of Medical Sciences, Lahore, Pakistan
fCorresponding Author: Muhammad Haisum Maqsood, Internal Medicine, King Edward Medical University, Lahore, Pakistan

Manuscript submitted August 7, 2019, accepted August 22, 2019
Short title: Air Embolism During ERCP


Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive procedure that is widely used by endoscopists and has a robust therapeutic profile. It uses endoscopy and imaging for a variety of diagnostic as well as therapeutic purposes. It is used for the management of a lot of pancreaticobiliary diseases such as obstructive jaundice, obstruction related to bile ducts, pancreatic biliary tumors, and traumatic or iatrogenic damage to the bile ducts. Other therapeutic interventions that can be done via ERCP include sphincterotomy, dilation of strictures, removal of biliary stones and placement of stents. Air embolism presents with cardiovascular, pulmonary, and neurologic signs and symptoms. Treatment of air embolism should be started early in suspected cases, and it should be in the differential diagnoses of various complications secondary to high risk of ERCP, especially if a cardiopulmonary compromise is present. Air embolism is rare but a serious complication associated with ERCP. The physicians must keep this in mind while performing ERCP in patients with predisposing risk factors. This review highlights the mechanism, causes, risk factors, pathophysiology, clinical signs, diagnostic modalities, treatment, and preventive measures to deal with this catastrophic complication.

Keywords: Air embolism; Pancreaticobiliary diseases; Endoscopy; Endoscopic retrograde cholangiopancreatography; Complications; Therapeutic procedure; Precordial Doppler ultrasound


Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive procedure which uses endoscopy and imaging for diagnostic and therapeutic purposes [1]. Its advantages in the management of pancreaticobiliary diseases are superseded by a higher potential for severe complications than any other standard endoscopic technique due to an extreme degree of expertise, procedural complexity and risk of complications [2]. Since its development in 1968, it has been in use as an excellent diagnostic tool for pancreaticobiliary diseases [3]. However, lately, its diagnostic use has transformed into an almost exclusively therapeutic procedure in support of less invasive techniques such as abdominal ultrasound (AUS) and magnetic resonance cholangiopancreatography (MRCP) [4]. Air embolism after ERCP is an uncommon complication that can be fatal if not recognized and treated early [5]. Air embolism is due to insufflation of high-pressured air to improve visualization. Different methods contributing to air embolism may include intramural dissection due to mucosal damage from high pressures, biliary venous fistulas, and blunt abdominal trauma [6]. According to Afreen et al there is a high incidence of 2.4% for venous air embolism (VAE) during ERCP which calls for the practitioners to be aware of it. Efficient detection can lead to early management, resulting in fewer consequences [7].

Air embolism due to ERCP is because of an abnormal entrance of air that is insufflated during the procedure into the arterial or venous vasculature due to disruption of a mucosal vascular barrier. Its severity is related to both the amount and the velocity with which the air is introduced [8, 9]. The amount of air that causes a circulatory air embolism ranges from 10 to 480 mL, depending on the speed of air entering into circulation and the organ vasculature into which the embolus extends [10]. Air embolism is a serious complication that can occur during an endoscopic procedure, and it can cause significant morbidity and mortality if not diagnosed early [11]. Therefore, it is imperative to keep the possibility of air embolism in mind whenever a patient experiences sudden deterioration of vitals or neurologic compromise, apart from other significant causes. We write this review article to describe the mechanism, causes, risk factors, pathophysiology, clinical signs, diagnostic modalities, treatment and preventive measures to deal with this catastrophic complication.

Uses and Complications of ERCP▴Top 

ERCP is an advanced endoscopic technique with a variety of diagnostic as well as therapeutic uses. It is used for the management of a lot of pancreaticobiliary diseases such as obstructive jaundice, obstruction related to bile ducts and pancreaticobiliary tumors, and traumatic or iatrogenic damage to the bile ducts [12]. Other therapeutic interventions that can be done via ERCP include sphincterotomy, dilation of strictures, removal of biliary stones, and placement of stents. Over 500,000 ERCPs are performed annually in the USA [13]. The Center for Medicare and Medicaid Services states that from 2000 to 2010, the number of cases of ERCP performed has risen from 233,378 to 288,715, a 23.7% increase [14, 15]. Gastrointestinal (GI) endoscopy involves insufflation of air at up to 2 L/min [16]. Cholangitis, hemorrhage, pancreatitis and perforation are the most common complications from ERCP [17]. Less common complications of ERCP include cardiac arrest, air in hepatic veins, pulmonary and cerebral air embolism, and paradoxical air embolism [17, 18]. Cardiopulmonary complications of ERCP include arrhythmias, hypoxemia and myocardial ischemia, which is usually transitory [17, 19]. Christensen and colleagues reported that 30% (12/40) patients underwent ST-segment changes suggesting myocardial ischemia. However, none of them had coronary symptoms on exercise stress test [19].

Pathophysiology of ERCP-Induced Air Embolism▴Top 

Patients who underwent prior endoscopic procedures are at a significantly higher risk for air embolism during ERCP. Placement of metal stents into the biliary tract may be associated with an increased risk of vascular injury, which favors air embolism [20]. The possible explanations of VAE during ERCP include mechanical alteration of the bile duct wall by the endoscope, development of bilio-venous shunts and spontaneous transgression of air from bile ducts [21]. Intramural dissection of air into the portal venous system via injured duodenal vein radicles can also occur following ERCP and sphincterotomy [6]. Other risk factors for air embolism during ERCP are inflammatory processes of the digestive system (pylephlebitis, inflammation of bile duct, inflammatory bowel disease, abscess and mesenteric ischemia), percutaneous biliary drainage, liver abscess, gastrointestinal tumors, transjugular intrahepatic portosystemic shunt (TIPS) and penetrating liver trauma [22]. Portal vein cannulation is also a cause of air embolism during ERCP [23, 24]. Air embolism rate associated with ERCP may be as high as 10% [25]. During ERCP, air from the luminal wall can enter into the venous or arterial system or both depending on where the primary insult began. When the gas enters a venous structure, VAE occurs, and the involvement of the organs depends upon the extension of the embolism. It can travel from the superior vena cava (SVC) through the right heart and end up causing pulmonary air embolism or can also pass through the SVC upwards into the cerebral veins leading to paradoxical air embolism. Also when a venous embolism is large enough, it can pass through the pulmonary veins and the left heart to the arterial circulation and end up lodging into cerebral arteries, one of the mechanisms behind paradoxical air embolism [26-28]. A patent foramen ovale can lead to paradoxical embolism [29]. Other than a patent foramen ovale, air embolus can also pass into the systemic circulation via a transpulmonary shunt [6, 30, 31]. Air-blood interface created due to the air embolus causes platelet activation, which leads to a further decline in blood flow across the pulmonary circulation [30].

Clinical Signs and Symptoms▴Top 

As most patients are sedated during the procedure, the clinical index of suspicion of air embolism should be kept in mind. Patients often experience severe and rapid clinical deterioration, so many cases often remain undiagnosed and are identified during post mortem [32]. Cardiovascular symptoms and signs include chest pain, dizziness, tachycardia or bradycardia, crackles, acute onset right-sided heart failure, hypotension, elevated jugular venous pressure, mill wheel murmur (loud churning sound likely from mixing of air and blood in the right ventricle that is heard throughout the cardiac cycle), cardiac arrest, arrhythmias like supraventricular tachycardia (SVT), ventricular tachycardia (VT), asystole or pulseless electrical activity [25, 31, 33-35]. Seizures, headache, focal neurological deficits, paraplegia or quadriparesis, altered mental status or failure to regain consciousness after the procedure, hemiparesis, pupillary dilation, skin mottling, and coma are some of the neurological signs and symptoms that may be present if cerebral involvement occurs [36-39]. Pulmonary symptoms and signs include respiratory failure, tachypnea, cyanosis, rales and wheezing [40]. A sudden decrease in end-tidal CO2 (EtCO2) in intubated patients may be a useful early sign of air embolism during ERCP. Nine out of the 10 reported fatalities from air embolism during ERCP occurred due to systemic embolization, which highlights the importance of early detection [41]. Severe cases of VAE may result in cardiovascular collapse. It was thought to be due to an “air-lock” phenomenon which resulted in large amounts of air entering into the right heart which prevented blood from exiting the ventricle. It now appears more likely that the acute increase in right ventricular pressure and decreased perfusion pressure leads to right ventricular ischemia, right heart failure, arrhythmias, and ultimately, cardiovascular collapse [7].


Precordial Doppler ultrasound (PDU) is a useful method to detect VAE during ERCP and should especially be considered in high-risk procedures [42]. It is an effective, inexpensive, and noninvasive monitoring device in which heart tone changes, usually called “mill-wheel murmur,” are a hallmark of VAE [8]. VAE may be diagnosed with transesophageal or transthoracic echocardiography [28]. Air can be seen in significant amount in the right heart. Pulmonary artery hypertension and right ventricular strain on electrocardiogram can also be seen. Because of a decrease in cardiac output, capnography demonstrates a decrease in EtCO2. If air is being used for insufflation, nitrogen will be seen among the expired gases [43]. Central venous pressure can be increased by volume expansion, which can prevent further embolization. A computed tomography scan can be done if systemic air embolism is suspected to identify air in the affected organs only after initial stabilization and resuscitation of the patient [44]. Moreover, pulmonary embolism should always be in the differentials of hemodynamic instability [11].


Treatment of air embolism should be started early in suspected cases, and it should be in the differential diagnoses of various complications secondary to high-risk ERCP, especially if a cardiopulmonary compromise is present [8]. Management of VAE is conservative with intravenous (IV) antibiotics and decompression via nasogastric tube [10]. If air embolism becomes evident during the procedure, the procedure should be discontinued, and hemodynamic and respiratory stabilization should be performed [45]. It is also recommended to perform an immediate echocardiogram [28]. If echocardiography confirms air in the right heart, the central catheter is inserted. High-flow 100% oxygen, Trendelenburg, and left lateral decubitus positions are used to prevent air migrating to the brain and to force the air into the outflow tract of the right ventricle [11]. Hyperbaric oxygen therapy is considered first-line treatment as it reduces the size of the air bubbles, increases nitrogen absorption, and increases blood oxygen concentration, which helps reduce cerebral ischemic injury [25]. Hyperbaric oxygen therapy in a chamber with a pressure of 2.5 atm for more than 2 h has shown to improve survival in patients with air embolisms from multiple sources [46]. Athauda et al reported a case where therapeutic hypothermia was used in cerebral air embolism caused by ERCP when hyperbaric oxygen therapy was not available. It is one of the secondary options, but more studies need to be done on this [38]. There is no routine recommendation of anticoagulation as there is a risk of hemorrhagic transformation of ischemic tissue. The only indication of anticoagulation in air embolism is the concomitant development of pulmonary embolism [11].

Mortality and Morbidity of Air Embolism▴Top 

Shaikh et al mentioned in their review that vascular air embolism has a mortality rate of 48-80% [47]. The lethal dose has been estimated to be 3 - 5 mL/kg and 300 - 500 mL of gas injected at a rate of 100 mL/s has been found to be fatal for humans [48]. Muley et al concluded that 17.2% (41/238) patients undergoing neurosurgery had a fall in EtCO2. Its monitoring is an important parameter to consider early in the course of suspected VAE. Survivors of VAE can have long-term neurological effects [49].

Prophylactic Measures to Decrease the Risk of Air Embolism▴Top 

Kwan and colleagues used CO2 instead of air, which reduced the risk of embolism as CO2 is absorbed more easily. It is also associated with less pain after the procedure and less abdominal distension [50]. The presence of congenital right-to-left shunt should be ruled out in all patients considered for ERCP, possibly via echocardiography before the procedure [5]. Personnel expertise is required to rapidly insert a pulmonary artery catheter into the right heart in order to drain air and should be immediately available [51]. Cotton et al highlighted that for diagnostic purposes, MRCP can now be used and ERCP should be reserved for the procedures that need therapeutic intervention [52].


Air embolism is a rare but serious complication associated with ERCP that must be considered, especially in high-risk cases. The endoscopist must keep this in mind while performing ERCP in patients with predisposing risk factors. Bedside Doppler may be used early to detect air in the right heart. Treatment with high-flow oxygen and resuscitation should be performed early in high-risk cases to prevent the fatal outcomes. After initial stabilization, diagnosis is then confirmed. Aspiration with the help of an expert should be readily available in high-risk cases. All high-risk cases should be intubated with the help of an anesthetist to detect reducing EtCO2 levels to initiate early treatment and reduce the morbidity and mortality associated with this.


None to declare.

Financial Disclosure

None to declare.

Conflict of Interest

None to declare.

Author Contributions

All authors made significant contribution to the idea, drafting and revisions of manuscript.

  1. ASGE Standards of Practice Committee, Chandrasekhara V, Khashab MA, Muthusamy VR, Acosta RD, Agrawal D, Bruining DH, et al. Adverse events associated with ERCP. Gastrointest Endosc. 2017;85(1):32-47.
    doi pubmed
  2. Finsterer J, Stollberger C, Bastovansky A. Cardiac and cerebral air embolism from endoscopic retrograde cholangio-pancreatography. Eur J Gastroenterol Hepatol. 2010;22(10):1157-1162.
    doi pubmed
  3. McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of vater: a preliminary report. Ann Surg. 1968;167(5):752-756.
    doi pubmed
  4. Adler DG, Baron TH, Davila RE, Egan J, Hirota WK, Leighton JA, Qureshi W, et al. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc. 2005;62(1):1-8.
    doi pubmed
  5. Wills-Sanin B, Cardenas YR, Polanco L, Rivero O, Suarez S, Buitrago AF. Air embolism after endoscopic retrograde cholangiopancreatography in a patient with budd Chiari syndrome. Case Rep Crit Care. 2014;2014:205081.
    doi pubmed
  6. Bisceglia M, Simeone A, Forlano R, Andriulli A, Pilotto A. Fatal systemic venous air embolism during endoscopic retrograde cholangiopancreatography. Adv Anat Pathol. 2009;16(4):255-262.
    doi pubmed
  7. Afreen LK, Bryant AS, Nakayama T, Ness TJ, Jones KA, Morgan CJ, Wilcox CM, et al. Incidence of venous air embolism during endoscopic retrograde cholangiopancreatography. Anesth Analg. 2018;127(2):420-423.
    doi pubmed
  8. Donepudi S, Chavalitdhamrong D, Pu L, Draganov PV. Air embolism complicating gastrointestinal endoscopy: A systematic review. World J Gastrointest Endosc. 2013;5(8):359-365.
    doi pubmed
  9. Borja AR, Masri Z, Shruck L, Pejo S. Unusual and lethal complications of infraclavicular subclavian vein catheterization. Int Surg. 1972;57(1):42-45.
  10. Mellado TP, Constanzo PF, Miquel PJ, Ibanez LP. [Ischemic brain infarction after an air embolism. Case report]. Rev Med Chil. 2005;133(4):453-456.
  11. Lanke G, Adler DG. Gas embolism during endoscopic retrograde cholangiopancreatography: diagnosis and management. Ann Gastroenterol. 2019;32(2):156-167.
    doi pubmed
  12. Chavalitdhamrong D, Donepudi S, Pu L, Draganov PV. Uncommon and rarely reported adverse events of endoscopic retrograde cholangiopancreatography. Dig Endosc. 2014;26(1):15-22.
    doi pubmed
  13. Andriulli A, Loperfido S, Napolitano G, Niro G, Valvano MR, Spirito F, Pilotto A, et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol. 2007;102(8):1781-1788.
    doi pubmed
  14. Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, Gangarosa LM, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143(5):1179-1187 e1173.
    doi pubmed
  15. Al-Awabdy B, Wilcox CM. Use of anesthesia on the rise in gastrointestinal endoscopy. World J Gastrointest Endosc. 2013;5(1):1-5.
    doi pubmed
  16. Di Pisa M, Chiaramonte G, Arcadipane A, Burgio G, Traina M. Air embolism during endoscopic retrograde cholangiopancreatography in a pediatric patient. Minerva Anestesiol. 2011;77(1):90-92.
  17. Dumonceau JM, Andriulli A, Deviere J, Mariani A, Rigaux J, Baron TH, Testoni PA, et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline: prophylaxis of post-ERCP pancreatitis. Endoscopy. 2010;42(6):503-515.
    doi pubmed
  18. ASGE Standards of Practice Committee, Anderson MA, Fisher L, Jain R, Evans JA, Appalaneni V, Ben-Menachem T, et al. Complications of ERCP. Gastrointest Endosc. 2012;75(3):467-473.
    doi pubmed
  19. Christensen M, Milland T, Rasmussen V, Schulze S, Rosenberg J. ECG changes during endoscopic retrograde cholangio-pancreatography and coronary artery disease. Scand J Gastroenterol. 2005;40(6):713-720.
    doi pubmed
  20. Rabe C, Balta Z, Wullner U, Heller J, Hammerstingl C, Tiemann K, Sommer T, et al. Biliary metal stents and air embolism: a note of caution. Endoscopy. 2006;38(6):648-650.
    doi pubmed
  21. Bastovansky A, Stollberger C, Finsterer J. Fatal cerebral air embolism due to a patent foramen ovale during endoscopic retrograde cholangiopancreatography. Clin Endosc. 2014;47(3):275-280.
    doi pubmed
  22. Cha ST, Kwon CI, Seon HG, Ko KH, Hong SP, Hwang SG, Park PW, et al. Fatal biliary-systemic air embolism during endoscopic retrograde cholangiopancreatography: a case with multifocal liver abscesses and choledochoduodenostomy. Yonsei Med J. 2010;51(2):287-290.
    doi pubmed
  23. Kalaitzakis E, Stern N, Sturgess R. Portal vein cannulation: an uncommon complication of endoscopic retrograde cholangiopancreatography. World J Gastroenterol. 2011;17(46):5131-5132.
    doi pubmed
  24. Furuzono M, Hirata N, Saitou J, Nakaji S. A rare complication during ERCP and sphincterotomy: placement of an endoscopic nasobiliary drainage tube in the portal vein. Gastrointest Endosc. 2009;70(3):588-590.
    doi pubmed
  25. Mohammedi I, Ber C, Peguet O, Ould-Aoudia T, Duperret S, Petit P. Cardiac air embolism after endoscopic retrograde cholangiopancreatography in a patient with blunt hepatic trauma. J Trauma. 2002;53(6):1170-1172.
    doi pubmed
  26. Lowdon JD, Tidmore TL, Jr. Fatal air embolism after gastrointestinal endoscopy. Anesthesiology. 1988;69(4):622-623.
    doi pubmed
  27. Desmond PV, MacMahon RA. Fatal air embolism following endoscopy of a hepatic portoenterostomy. Endoscopy. 1990;22(5):236.
    doi pubmed
  28. Gottdiener JS, Papademetriou V, Notargiacomo A, Park WY, Cutler DJ. Incidence and cardiac effects of systemic venous air embolism. Echocardiographic evidence of arterial embolization via noncardiac shunt. Arch Intern Med. 1988;148(4):795-800.
    doi pubmed
  29. Duburque C, Beaujard E, Landel JB, Rihani R, Merouani K, Yassine W, Lucidarme O, et al. Life-threatening air embolism during ERCP. Endoscopy. 2014;46(Suppl 1 UCTN):E250-251.
    doi pubmed
  30. Root B, Levy MN, Pollack S, Lubert M, Pathak K. Gas embolism death after laparoscopy delayed by "trapping" in portal circulation. Anesth Analg. 1978;57(2):232-237.
    doi pubmed
  31. Stabile L, Cigada M, Stillittano D, Morandi E, Zaffroni M, Rossi G, Lapichino G. Fatal cerebral air embolism after endoscopic retrograde cholangiopancreatography. Acta Anaesthesiol Scand. 2006;50(5):648-649.
    doi pubmed
  32. Jorens PG, Van Marck E, Snoeckx A, Parizel PM. Nonthrombotic pulmonary embolism. Eur Respir J. 2009;34(2):452-474.
    doi pubmed
  33. Sisk JM, Choi MD, Casabianca AB, Hassan AM. Two Cardiac Arrests Because of Venous Air Embolism During Endoscopic Retrograde Cholangiopancreatography: A Case Report. A A Case Rep. 2017;8(3):47-50.
    doi pubmed
  34. Marchesi M, Battistini A, Pellegrinelli M, Gentile G, Zoja R. Fatal air embolism during endoscopic retrograde cholangiopancreatography (ERCP): An 'impossible' diagnosis for the forensic pathologist. Med Sci Law. 2016;56(1):70-73.
    doi pubmed
  35. Hauser G, Milosevic M, Zelic M, Stimac D. Sudden death after endoscopic retrograde cholangiopancreatography (ERCP) - case report and literature review. Medicine (Baltimore). 2014;93(27):e235.
    doi pubmed
  36. Trabanco S, Pardo S, Williams M, Diaz J, Ruiz C. Cerebral air embolism after ERCP. J Clin Anesth. 2017;36:133-135.
    doi pubmed
  37. Markin NW, Montzingo CR. Paradoxical air embolus during endoscopic retrograde cholangiopancreatography: an uncommon fatal complication. A A Case Rep. 2015;4(7):87-90.
    doi pubmed
  38. Athauda D, Tan GS, De Pablo-Fernandez E. Cerebral air embolism during endoscopic retrograde cholangiopancreatography: treatment with therapeutic hypothermia. Endoscopy. 2014;46(Suppl 1 UCTN):E151-152.
    doi pubmed
  39. Vachalova I, Ernst S, Vynogradova I, Wohrmann S, Heckmann JG. Cerebral air embolism via port catheter and endoscopic retrograde cholangio-pancreatography. Springerplus. 2013;2:477.
    doi pubmed
  40. Bechi A, Nucera MP, Olivotto I, Manetti R, Fabbri LP. Complete neurological recovery after systemic air embolism during endoscopic retrograde cholangiopancreatography. Minerva Anestesiol. 2012;78(5):622-625.
  41. Mathew J, Jr., Parker C, 3rd, Wang J. Pulseless electrical activity arrest due to air embolism during endoscopic retrograde cholangiopancreatography: a case report and review of the literature. BMJ Open Gastroenterol. 2015;2(1):e000046.
    doi pubmed
  42. Tedim A, Amorim P, Castro A. Development of a system for the automatic detection of air embolism using a precordial Doppler. Conf Proc IEEE Eng Med Biol Soc. 2014;2014:2306-2309.
    doi pubmed
  43. Nern C, Bellut D, Husain N, Pangalu A, Schwarz U, Valavanis A. Fatal cerebral venous air embolism during endoscopic retrograde cholangiopancreatography-case report and review of the literature. Clin Neuroradiol. 2012;22(4):371-374.
    doi pubmed
  44. Mirski MA, Lele AV, Fitzsimmons L, Toung TJ. Diagnosis and treatment of vascular air embolism. Anesthesiology. 2007;106(1):164-177.
    doi pubmed
  45. Murphy BP, Harford FJ, Cramer FS. Cerebral air embolism resulting from invasive medical procedures. Treatment with hyperbaric oxygen. Ann Surg. 1985;201(2):242-245.
    doi pubmed
  46. Raju GS, Bendixen BH, Khan J, Summers RW. Cerebrovascular accident during endoscopy: consider cerebral air embolism, a rapidly reversible event with hyperbaric oxygen therapy. Gastrointest Endosc. 1998;47(1):70-73.
  47. Shaikh N, Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock. 2009;2(3):180-185.
    doi pubmed
  48. Kauczor HU, Riepert T, Wolcke B, Lasczkowski G, Mildenberger P. Fatal venous air embolism: proof and volumetry by helical CT. Eur J Radiol. 1995;21(2):155-157.
  49. Muley SS, Saini SS, Dash HH, Bithal PK. End tidal carbon dioxide monitoring for detection of venous air embolism. Indian J Med Res. 1990;92:362-366.
  50. Kwan M, Cheong KL, Siew Ching Koay D, Zorron Cheng Tao Pu L, Singh R. A prospective randomised controlled trial comparing carbon dioxide and air insufflation during ERCP: Is it worth the pain? GastroHep. 2019; 1(1): 5-10.
  51. Squara P, Bennett D, Perret C. Pulmonary artery catheter: does the problem lie in the users? Chest. 2002;121(6):2009-2015.
    doi pubmed
  52. Cotton PB, Garrow DA, Gallagher J, Romagnuolo J. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc. 2009;70(1):80-88.
    doi pubmed

This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Gastroenterology Research is published by Elmer Press Inc.


Browse  Journals  


Journal of Clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics


World Journal of Oncology

Gastroenterology Research

Journal of Hematology


Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity


Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research


Journal of Neurology Research

International Journal of Clinical Pediatrics



Gastroenterology Research, bimonthly, ISSN 1918-2805 (print), 1918-2813 (online), published by Elmer Press Inc.                     
The content of this site is intended for health care professionals.

This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)

This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website:   editorial contact:
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.

Disclaimer: The views and opinions expressed in the published articles are those of the authors and do not necessarily reflect the views or opinions of the editors and Elmer Press Inc. This website is provided for medical research and informational purposes only and does not constitute any medical advice or professional services. The information provided in this journal should not be used for diagnosis and treatment, those seeking medical advice should always consult with a licensed physician.