title: Risk Factors for Aspiration Pneumonia After Endoscopic Hemostasis.
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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Kawanishi
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811 Kimiidera, Wakayama City, Wakayama, 641-0012, Japan. katojun@wakayama-med.ac.jp.
authors.forename: Jun
authors.initials: J
authors.lastname: Kato
authors.affiliation: Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Toda
authors.affiliation: Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Yamagami
authors.affiliation: Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kojima
authors.affiliation: Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Takamasa
authors.initials: T
authors.lastname: Ohki
authors.affiliation: Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Michiharu
authors.initials: M
authors.lastname: Seki
authors.affiliation: Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Tagawa
mesh_terms: D000367:Age Factors; D000368:Aged; D057908:Argon Plasma Coagulation; D015331:Cohort Studies; D015897:Comorbidity; D003487:Cyanoacrylates / Q000627:therapeutic use; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000601:surgery*; D006489:Hemostatic Techniques; D006501:Hepatic Encephalopathy / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D008026:Ligation; D016015:Logistic Models; D008297:Male; D008309:Mallory-Weiss Syndrome / Q000453:epidemiology / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D061646:Operative Time; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology / Q000601:surgery*; D011015:Pneumonia, Aspiration / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D013525:Surgical Instruments
chemical_list: D003487:Cyanoacrylates
keywords: Conscious sedation; Emergency endoscopy; Hemodialysis; Procedure time; Stroke; Upper gastrointestinal bleeding