Endoscopists Spot Gut Mucosal Changes During Anesthesia-Related Anaphylaxis

Two patients undergoing sedation for painless gastrointestinal endoscopy developed anesthesia-related anaphylaxis, and in both cases the endoscope itself revealed an unexpected warning sign: visible changes in the gastrointestinal mucosa, including pale swelling and a distinctive flower-like appearance, according to a case report published in BMC Anesthesiology.

Perioperative anaphylaxis is rare but potentially life-threatening, and the report’s authors note that timely recognition during anesthesia can be challenging.

In the first case, the reaction escalated to anaphylactic shock requiring cardiopulmonary resuscitation, after which the patient’s vital signs recovered. The second patient’s hemodynamics stabilized following treatment. In both instances, the endoscopists observed pale edema of the gastrointestinal lining along with the characteristic flower-like mucosal pattern as the reactions unfolded.

Both patients received epinephrine and supportive treatment. In the second patient, hemodynamics stabilized and the mucosal appearance returned to normal after intravenous epinephrine and supportive care. No adverse events occurred during follow-up in either case.

The observation suggests that mucosal changes visible through the endoscope may serve as an additional clue during an evolving anaphylactic reaction.

The authors emphasize that these findings are supplementary rather than diagnostic on their own. Cutaneous, cardiovascular, and respiratory manifestations remain the well-recognized hallmarks of anaphylaxis, and the mucosal changes should be interpreted alongside those signs and the overall clinical picture rather than in isolation.

As a two-case report, the evidence is limited by design. Case reports describe individual experiences and cannot establish how frequently such mucosal changes occur during anaphylaxis, how specific they are, or whether recognizing them improves outcomes. Those questions would require larger systematic studies.

Nevertheless, the report highlights a practical point for endoscopy teams: during sedation, the endoscopic view may capture early physical signs of a systemic allergic reaction. The authors suggest that awareness of these mucosal findings could provide supplementary information for the clinical assessment of suspected anaphylaxis during painless gastrointestinal endoscopy.

The article was published open access on 22 October 2026 and is currently available as a peer-reviewed accepted manuscript, a version that may still be edited before the final Version of Record replaces it.

Subject of Research: Gastrointestinal mucosal changes observed during anesthesia-related anaphylaxis in painless gastrointestinal endoscopy

Article Title: Gastrointestinal mucosal changes as an endoscopic clue to anesthesia-related anaphylaxis during painless gastrointestinal endoscopy: two case reports

Article References: Chen, J.-Q., Li, H.-X., Jing, M.-Z., & Xing, N. (2026). Gastrointestinal mucosal changes as an endoscopic clue to anesthesia-related anaphylaxis during painless gastrointestinal endoscopy: two case reports. BMC Anesthesiology. https://doi.org/10.1186/s12871-026-04357-y

Image Credits: AI Generated

DOI: 10.1186/s12871-026-04357-y

Keywords: anaphylaxis, anesthesia, endoscopy, gastrointestinal mucosa, case report, epinephrine, anaphylactic shock, painless endoscopy, BMC Anesthesiology, drug allergy, Gastrointestinal, mucosal