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

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Abstract

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.

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References

  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 98:2424–2434

    Article  PubMed  Google Scholar 

  2. Grace ND (2001) Diagnosis and treatment of gastrointestinal bleeding secondary to portal hypertension. American College of Gastroenterology Practice Parameters Committee. Am J Gastroenterol 96:3039–3040

    Article  Google Scholar 

  3. Chalasani N, Kahi C, Francois F, et al (2003) Improved patient survival after acute variceal bleeding: a multicenter, cohort study. Am J Gastroenterol 98:653–659

    Article  PubMed  Google Scholar 

  4. Graham DY, Smith JL (1981) The course of patients after variceal hemorrhage. Gastroenterology 80:800–809

    PubMed  CAS  Google Scholar 

  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 268:469–473

    Article  PubMed  CAS  Google Scholar 

  6. Katz D (1969) Morbidity and mortality in standard flexible gastrointestinal endoscopy. Gastrointest Endosc 15:134–141

    PubMed  CAS  Google Scholar 

  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 235:928–930

    Article  PubMed  CAS  Google Scholar 

  8. Katon RM (1981) Complications of upper gastrointestinal endoscopy in the gastrointestinal bleeder. Dig Dis Sci 26:47S–54S

    Article  PubMed  CAS  Google Scholar 

  9. Gilbert DA, Silverstein FE, Tedesco FJ (1981) National ASGE survey on upper gastrointestinal bleeding: complications of endoscopy. Dig Dis Sci 26:55S–59S

    Article  PubMed  CAS  Google Scholar 

  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 27:94–102

    PubMed  CAS  Google Scholar 

  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 2:505–509

    PubMed  CAS  Google Scholar 

  12. Palmer ED (1969) The vigorous diagnostic approach to upper-gastrointestinal tract hemorrhage. JAMA 207:1477–1480

    Article  PubMed  CAS  Google Scholar 

  13. Sandlow LJ, Becker GH, Spellberg MA, et al (1974) A prospective randomized study of the management of upper gastrointestinal hemorrhage. Am J Gastroenterol 61:282–289

    PubMed  CAS  Google Scholar 

  14. Allan R, Dykes P (1976) A study of the factors influencing mortality rates from gastrointestinal hemorrhage. Q J Med 180:533–550

    Google Scholar 

  15. Rudolph SJ, Landsverk BK, Freeman ML (2003) Endotracheal intubation for airway protection during endoscopy for severe upper GI hemorrhage. Gastrointest Endosc 57:58–61

    Article  PubMed  Google Scholar 

  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 23:16–19

    Google Scholar 

  17. Eimiller A (1992) Complication in endoscopy. Endoscopy 24:176–184

    PubMed  CAS  Google Scholar 

  18. Schiller K, Cotton P, Salmon P (1972) The hazards of digestive fibroendoscopy. A survey of the British experience. Gut 13:1027

    PubMed  CAS  Google Scholar 

  19. Prout B, Metreweli C (1972) Pulmonary aspiration after fibroendoscopy of the upper gastrointestinal tract. Br Med J 4:269–271

    Article  PubMed  CAS  Google Scholar 

  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 19:1152–1157

    Article  PubMed  CAS  Google Scholar 

  21. Lipper B, Douglas S, Cerrone F (1991) Pulmonary aspiration during emergency endoscopy in patients with upper gastrointestinal hemorrhage. Crit Care Med 19:330–333

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA

    David G. Koch

  2. Division of Gastroenterology & Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA

    Miguel R. Arguedas & Michael B. Fallon

  3. Digestive Disease Center, Medical University of South Carolina, 96 Jonathan Lucas Street, 210 Clinical Sciences Building, Charleston, South Carolina, 29425, USA

    David G. Koch

Authors
  1. David G. Koch
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  2. Miguel R. Arguedas
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  3. Michael B. Fallon
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Correspondence to David G. Koch.

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Koch, D.G., Arguedas, M.R. & Fallon, M.B. Risk of Aspiration Pneumonia in Suspected Variceal Hemorrhage: The Value of Prophylactic Endotracheal Intubation Prior to Endoscopy. Dig Dis Sci 52, 2225–2228 (2007). https://doi.org/10.1007/s10620-006-9616-0

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  • DOI: https://doi.org/10.1007/s10620-006-9616-0

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