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Bubble Trouble: Venous Air Embolism in Endoscopic Retrograde Cholangiopancreatography

Wanderer, Jonathan P. MD, MPhil; Nathan, Naveen MD

doi: 10.1213/ANE.0000000000003599
Infographics: Infographic

Vanderbilt University School of Medicine (

Northwestern University Feinberg School of Medicine (

The Infographic is composed by Jonathan P. Wanderer, MD, MPhil, Vanderbilt University School of Medicine (, and Naveen Nathan, MD, Northwestern University Feinberg School of Medicine ( Illustration by Naveen Nathan, MD.

The authors declare no conflicts of interest.

The advent of advanced endoscopy has brought about a new era of diagnostic and therapeutic procedures, which have the potential to address disease in less invasive manner. However, these procedures bring their own set of risks, such as pancreatitis, cholangitis, bleeding, perforation, and sedation risks. In addition, venous air embolism is a potentially catastrophic complication. In this infographic, we review the risk factors and incidence of venous air embolism in endoscopic retrograde cholangiopancreatography and highlight the associated procedures that have the highest degree of associated risk.

ERCP indicates endoscopic retrograde cholangiopancreatography; VAE, venous air embolism.

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1. Afreen LK, Nakayama T, Bryant AS, et al. Incidence of venous air embolism during endoscopic retrograde cholangiopancreatography. Anesth Analg. 2018;127:420–423.
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