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Digestive Diseases and Sciences

, Volume 61, Issue 3, pp 835–840 | Cite as

Risk Factors for Aspiration Pneumonia After Endoscopic Hemostasis

  • Koki Kawanishi
  • Jun Kato
  • Nobuo Toda
  • Mari Yamagami
  • Tomoharu Yamada
  • Kentaro Kojima
  • Takamasa Ohki
  • Michiharu Seki
  • Kazumi Tagawa
Original Article

Abstract

Background

Although all types of endoscopic procedures harbor risk of aspiration, little is understood about risk factors for aspiration pneumonia developing after endoscopic hemostasis.

Aims

The present study aimed to identify risk factors for aspiration pneumonia after endoscopic hemostasis.

Methods

Charts from consecutive patients with upper gastrointestinal bleeding that had been treated by endoscopic hemostasis at a single center between January 2004 and January 2015 were retrospectively reviewed. Patient information and clinical characteristics including cause of hemorrhage, established prognostic scales, laboratory data, comorbidities, medications, duration of endoscopic hemostasis, vital signs, sedative use, and the main operator during the procedure were compared between patients who developed aspiration pneumonia and those who did not.

Results

Aspiration pneumonia developed in 24 (4.8 %) of 504 patients after endoscopic hemostasis. Endotracheal intubation was required for three of them, and one died of the complication. Multivariate analysis revealed that age >75 years (odds ratio (OR) 4.4; 95 % confidence interval (CI) 1.5–13.6; p = 0.0073), procedural duration >30 min (OR 5.6; 95 % CI 1.9–18.2; p = 0.0023), hemodialysis (OR 3.6; 95 % CI 1.2–11; p = 0.024), and a history of stroke (OR 3.8; 95 % CI 1–14; p = 0.041) were independent risk factors for developing aspiration pneumonia.

Conclusions

Specific risk factors for aspiration pneumonia after endoscopic hemostasis were identified. Endoscopists should carefully consider aspiration pneumonia when managing older patients who are on hemodialysis, have a history of stroke, and undergo a longer procedure.

Keywords

Conscious sedation Emergency endoscopy Hemodialysis Procedure time Stroke Upper gastrointestinal bleeding 

Abbreviations

ESD

Endoscopic submucosal dissection

GI

Gastrointestinal

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare in relation to this study.

References

  1. 1.
    Gong EJ, Kim DH, Jung H-Y, et al. Pneumonia after endoscopic resection for gastric neoplasm. Dig Dis Sci. 2014;59:2742–2748.CrossRefPubMedGoogle Scholar
  2. 2.
    Park CH, Kim H, Kang YA, et al. Risk factors and prognosis of pulmonary complications after endoscopic submucosal dissection for gastric neoplasia. Dig Dis Sci. 2013;58:540–546.CrossRefPubMedGoogle Scholar
  3. 3.
    Akasaka T, Nishida T, Tsutsui S, et al. Short-term outcomes of endoscopic submucosal dissection (ESD) for early gastric neoplasm: multicenter survey by osaka university ESD study group. Dig Endosc. 2011;23:73–77.CrossRefPubMedGoogle Scholar
  4. 4.
    Schneider AS, Schettler A, Markowski A, et al. Complication and mortality rate after percutaneous endoscopic gastrostomy are low and indication-dependent. Scand J Gastroenterol. 2014;49:891–898.CrossRefPubMedGoogle Scholar
  5. 5.
    Koc D, Gercek A, Gencosmanoglu R, Tozun N. Percutaneous endoscopic gastrostomy in the neurosurgical intensive care unit: complications and outcome. J Parenter Enteral Nutr. 2007;31:517–520.CrossRefGoogle Scholar
  6. 6.
    Nicholson FB, Korman MG, Richardson MA. Percutaneous endoscopic gastrostomy: a review of indications, complications and outcome. J Gastroenterol Hepatol. 2000;15:21–25.CrossRefPubMedGoogle Scholar
  7. 7.
    Rudolph SJ, Landsverk BK, Freeman ML. Endotracheal intubation for airway protection during endoscopy for severe upper GI hemorrhage. Gastrointest Endosc. 2003;57:58–61.CrossRefPubMedGoogle Scholar
  8. 8.
    Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38:316–321.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000;356:1318–1321.CrossRefPubMedGoogle Scholar
  10. 10.
    Saltzman JR, Tabak YP, Hyett BH, Sun X, Travis AC, Johannes RS. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc. 2011;74:1215–1224.CrossRefPubMedGoogle Scholar
  11. 11.
    Koch DG, Arguedas MR, Fallon MB. Risk of aspiration pneumonia in suspected variceal hemorrhage: the value of prophylactic endotracheal intubation prior to endoscopy. Dig Dis Sci. 2007;52:2225–2228.CrossRefPubMedGoogle Scholar
  12. 12.
    Rehman A, Iscimen R, Yilmaz M, et al. Prophylactic endotracheal intubation in critically ill patients undergoing endoscopy for upper GI hemorrhage. Gastrointest Endosc. 2009;69:55–59.CrossRefGoogle Scholar
  13. 13.
    Almashhrawi AA, Rahman R, Jersak ST, et al. Prophylactic tracheal intubation for upper GI bleeding: a meta-analysis. World J Meta-anal. 2015;3:4–10.CrossRefGoogle Scholar
  14. 14.
    Cooper GS, Kou TD, Rex DK. Complications following colonoscopy with anesthesia assistance: a population-based analysis. JAMA Intern Med. 2013;173:551–556.PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Tierney WM, Adler DG, Conway JD, et al. Overtube use in gastrointestinal endoscopy. Gastrointest Endosc. 2009;70:828–834.CrossRefPubMedGoogle Scholar
  16. 16.
    Aslan F, Seren AR, Akpinar Z, et al. The usage of overtube has a favorable effect on endoscopic submucosal dissection. Surg Endosc. 2014;28:262–263.Google Scholar
  17. 17.
    Maekita T, Kato J, Nakatani Y, et al. Usefulness of continuous suction mouthpiece during esophagogastroduodenoscopy: a single-center, prospective, randomized study. World J Gastrointest Endosc. 2013;5:508–513.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Maekita T, Kato J, Nakatani Y, et al. Usefulness of a continuous suction mouthpiece during percutaneous endoscopic gastrostomy: a single-center, prospective, randomized study. Dig Endosc. 2013;25:496–501.CrossRefPubMedGoogle Scholar
  19. 19.
    Sohrabi Z, Eftekhari MH, Eskandari MH, Rezaeianzadeh A, Sagheb MM. Malnutrition-inflammation score and quality of life in hemodialysis patients: is there any correlation? Nephrourol Mon. 2015;7:27445.Google Scholar
  20. 20.
    Mikolašević I, Orlić L, Vidrih S, et al. Assessment of nutritional status in patients with chronic kidney disease on maintance hemodialysis. Acta Med Croat. 2014;68:97–102.Google Scholar
  21. 21.
    Bouchard J, Presse N, Ferland G. Association between aspiration pneumonia and malnutrition in patients from active geriatric units. Can J Diet Pract Res. 2009;70:152–154.CrossRefPubMedGoogle Scholar
  22. 22.
    de Oliveira ARS, de Costa AGS, Morais HCC, Cavalcante TF, de Lopes MVO, de Araujo TL. Clinical factors predicting risk for aspiration and respiratory aspiration among patients with stroke. Rev Lat Am Enferm. 2015;23:216–224.CrossRefGoogle Scholar
  23. 23.
    Kikawada M, Iwamoto T, Takasaki M. Aspiration and infection in the elderly: epidemiology, diagnosis and management. Drugs Aging. 2005;22:115–130.CrossRefPubMedGoogle Scholar
  24. 24.
    Yamamoto K, Koh H, Shimada H, et al. Cerebral infarction in the left hemisphere compared with the right hemisphere increases the risk of aspiration pneumonia. Osaka City Med J. 2014;60:81–86.PubMedGoogle Scholar
  25. 25.
    Van der Maarel-Wierink CD, Vanobbergen JNO, Bronkhorst EM, Schols JMGA, de Baat C. Risk factors for aspiration pneumonia in frail older people: a systematic literature review. J Am Med Dir Assoc. 2011;12:344–354.CrossRefPubMedGoogle Scholar
  26. 26.
    Watari J, Tomita T, Toyoshima F, et al. The incidence of “silent” free air and aspiration pneumonia detected by CT after gastric endoscopic submucosal dissection. Gastrointest Endosc. 2012;76:1116–1123.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Koki Kawanishi
    • 1
  • Jun Kato
    • 2
  • Nobuo Toda
    • 1
  • Mari Yamagami
    • 1
  • Tomoharu Yamada
    • 1
  • Kentaro Kojima
    • 1
  • Takamasa Ohki
    • 1
  • Michiharu Seki
    • 1
  • Kazumi Tagawa
    • 1
  1. 1.Department of GastroenterologyMitsui Memorial HospitalChiyoda-kuJapan
  2. 2.Second Department of Internal MedicineWakayama Medical UniversityWakayama CityJapan

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