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Esophagogastrodudenoscopy (EGD) Clearance for Transesophageal Echocardiogram (TEE) in Patients with Esophageal Disease

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Lee, David M.D.; Sideridis, Kostas M.D.; Pooran, Nakechand M.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S39
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Division of Gastroenterology, Long Island Jewish Medical Center, New Hyde Park, NY.

Purpose: TEE is more sensitive than transthoracic echocardiography (TTE) in evaluating valvular heart disease and cardiac thrombus. Complication rates for TEE are reported to be 0.88%. If a patient history is suggestive of gastroesophageal disease, evaluation of the esophagus prior to TEE may be indicated. To investigate whether EGD is warranted prior to TEE we recorded EGD findings, TEE findings and complications.

Methods: We prospectively followed 36 patients (18F, 18M) who were referred for esophageal evaluation prior to TEE at Long Island Jewish Hospital from 2003–2005. We recorded why esophageal evaluation was requested, EGD findings, TEE results, and for any complications occurring during hospitalization.

Results: The mean age was 60 years. Six patients (16.7%) were refered for evaluation because of gastroesophageal reflux disease, 9 (25%) complained of dysphagia, 8 (22.2%) had a history of cirrhosis or alcohol abuse, and 13 (36.1%) had anemia or guiaic positive stools. EGD findings were normal in 6 patients (16.7%), 5 (13.9%) had esophagitis, 13 (36.1%) had peptic ulcer disease or non-specific gastritis, and 8 (22.2%) had a hiatal hernia. Five patients (13.9%) who were evaluated by EGD did not have a TEE. Only 2 patients (5.4%) were cancelled due to EGD findings (tortuous esophagus, esophageal varices), while the remaining 3 patients (8.1%) were cancelled due to unsuccessful intubation by the TEE scope. There was no complication among those who successfully had TEE.

Conclusions: Although majority of the patients had endoscopic findings on EGD, these findings rarely precluded performing a TEE. TEE is a relatively safe procedure, and an EGD prior may be unnecessary. Larger studies are needed to validate these results and to investigate criteria for the use of EGD in patients undergoing TEE.

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