CO2 insufflation in endoscopy reduces risk of gas embolism

ANZCA has been alerted to the death of a person from a suspected venous air embolism sustained during an endoscopic retrograde cholangiopancreatography (ERCP) procedure, in which air rather than CO₂ had been used for insufflation.

Hospital endoscopy units may be set up to use air for insufflation in gastrointestinal endoscopy procedures. Evidence suggests using CO₂ instead of air for insufflation reduces the risk of embolism, as CO₂ is more readily absorbed. For a number of endoscopy procedures, CO₂ is also associated with reduced postprocedural pain and less abdominal distension.

ANZCA advises that fellows be aware when air insufflation is in use in endoscopy procedures. Maintain a high index of clinical suspicion of gas embolism if there is any abrupt change in vital signs or neurological status during or after the procedure, as aggressive treatment is needed to avoid a fatal outcome.

Further reading on diagnosis and management of air embolism during endoscopy and/or ERCP is below:

• Basavana G, Saumoy M. Anesthesia for Advanced Endoscopic Procedures. Clin Endosc 2022; 55(1): 1-7. DOI: https://doi.org/10.5946/ce.2021.236
• Lanke G, Adler DG. Gas embolism during endoscopic retrograde cholangiopancreatography: diagnosis and management. Ann Gastroenterol. 2019;32(2):156-167. doi:10.20524/aog.2018.0339