Digestive Diseases and Sciences

, Volume 52, Issue 9, pp 2225–2228 | Cite as

Risk of Aspiration Pneumonia in Suspected Variceal Hemorrhage: The Value of Prophylactic Endotracheal Intubation Prior to Endoscopy

  • David G. KochEmail author
  • Miguel R. Arguedas
  • Michael B. Fallon
Original Article


Variceal hemorrhage (VH) is a lethal complication of portal hypertension. Aspiration occurring during endoscopic intervention for acute VH is a concern; however, few data exist regarding the efficacy of prophylactic intubation to prevent aspiration pneumonia. We reviewed all endoscopic procedures for acute VH from January 1995 to December 2002; only patients with the absence of hepatic encephalopathy greater than stage II and normal chest x-ray at admission were included. The use of prophylactic intubation, postprocedure chest x-ray, and mortality were recorded. Sixty-two patients (69 bleeding episodes) were identified. Elective intubation was performed in 42 patients (47 episodes); pulmonary infiltrates developed in 7 of 42 (17%), with an overall mortality rate of 9 of 42 (21%). Twenty patients (22 episodes) were not intubated. None developed pulmonary infiltrates, and the overall mortality rate was 1 in 20 (5%). We conclude that in patients with suspected variceal bleeding, elective intubation is associated with a substantial risk of aspiration pneumonia.


Gastrointestinal hemorrhage Esophageal varices Endoscopy Aspiration pneumonia Endotracheal intubation Hepatic encephalopathy 


  1. 1.
    Sorbi D, Gostout CJ, Peura D (2003) An assessment of the management of acute bleeding varices: a multicenter prospective member-based study. Am J Gastroenterol 98:2424–2434PubMedCrossRefGoogle Scholar
  2. 2.
    Grace ND (2001) Diagnosis and treatment of gastrointestinal bleeding secondary to portal hypertension. American College of Gastroenterology Practice Parameters Committee. Am J Gastroenterol 96:3039–3040CrossRefGoogle Scholar
  3. 3.
    Chalasani N, Kahi C, Francois F, et al (2003) Improved patient survival after acute variceal bleeding: a multicenter, cohort study. Am J Gastroenterol 98:653–659PubMedCrossRefGoogle Scholar
  4. 4.
    Graham DY, Smith JL (1981) The course of patients after variceal hemorrhage. Gastroenterology 80:800–809PubMedGoogle Scholar
  5. 5.
    Garceau AJ, Chalmers TC, Boston Inter-Hospital Liver Group (1963) The natural history of cirrhosis. I. Survival with esophageal varices. N Engl J Med 268:469–473PubMedCrossRefGoogle Scholar
  6. 6.
    Katz D (1969) Morbidity and mortality in standard flexible gastrointestinal endoscopy. Gastrointest Endosc 15:134–141PubMedGoogle Scholar
  7. 7.
    Silvis SE, Nebel O, Rogers G, Sugawa C, Mandelstam P (1976) Endoscopic complications. Results of the 1974 American Society for Gastrointestinal Endoscopy Survey. JAMA 235:928–930PubMedCrossRefGoogle Scholar
  8. 8.
    Katon RM (1981) Complications of upper gastrointestinal endoscopy in the gastrointestinal bleeder. Dig Dis Sci 26:47S–54SPubMedCrossRefGoogle Scholar
  9. 9.
    Gilbert DA, Silverstein FE, Tedesco FJ (1981) National ASGE survey on upper gastrointestinal bleeding: complications of endoscopy. Dig Dis Sci 26:55S–59SPubMedCrossRefGoogle Scholar
  10. 10.
    Gilbert DA, Silverstein FE, Tedesco FJ, et al (1981) The National ASGE Survey on Upper Gastrointestinal Bleeding. III. Endoscopy after upper gastrointestinal bleeding. Gastrointest Endosc 27:94–102PubMedGoogle Scholar
  11. 11.
    Cotton PB, Rosenberg MT, Waldram RP, Axon AT (1973) Early endoscopy of oesophagus, stomach, and duodenal bulb in patients with haematemesis and melaena. Br Med J 2:505–509PubMedGoogle Scholar
  12. 12.
    Palmer ED (1969) The vigorous diagnostic approach to upper-gastrointestinal tract hemorrhage. JAMA 207:1477–1480PubMedCrossRefGoogle Scholar
  13. 13.
    Sandlow LJ, Becker GH, Spellberg MA, et al (1974) A prospective randomized study of the management of upper gastrointestinal hemorrhage. Am J Gastroenterol 61:282–289PubMedGoogle Scholar
  14. 14.
    Allan R, Dykes P (1976) A study of the factors influencing mortality rates from gastrointestinal hemorrhage. Q J Med 180:533–550Google Scholar
  15. 15.
    Rudolph SJ, Landsverk BK, Freeman ML (2003) Endotracheal intubation for airway protection during endoscopy for severe upper GI hemorrhage. Gastrointest Endosc 57:58–61PubMedCrossRefGoogle Scholar
  16. 16.
    Mandelstam P, Sugawa C, Silvis SE, Nebel OT, Rogers BH (1979) Complications associated with esophagogastroduodenoscopy and with esophageal dilatation. An analysis of the 1974 ASGE survey. Gastrointest Endosc 23:16–19Google Scholar
  17. 17.
    Eimiller A (1992) Complication in endoscopy. Endoscopy 24:176–184PubMedGoogle Scholar
  18. 18.
    Schiller K, Cotton P, Salmon P (1972) The hazards of digestive fibroendoscopy. A survey of the British experience. Gut 13:1027PubMedGoogle Scholar
  19. 19.
    Prout B, Metreweli C (1972) Pulmonary aspiration after fibroendoscopy of the upper gastrointestinal tract. Br Med J 4:269–271PubMedCrossRefGoogle Scholar
  20. 20.
    Liebler J, Benner K, Putnam T, Vollmer W (1991) Respiratory complications in critically ill medical patients with acute upper gastrointestinal bleeding. Crit Care Med 19:1152–1157PubMedCrossRefGoogle Scholar
  21. 21.
    Lipper B, Douglas S, Cerrone F (1991) Pulmonary aspiration during emergency endoscopy in patients with upper gastrointestinal hemorrhage. Crit Care Med 19:330–333PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  • David G. Koch
    • 1
    • 3
    Email author
  • Miguel R. Arguedas
    • 2
  • Michael B. Fallon
    • 2
  1. 1.Department of Internal MedicineUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Division of Gastroenterology & HepatologyUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.Digestive Disease CenterMedical University of South CarolinaCharlestonUSA

Personalised recommendations