SAFETY OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY WITHOUT VARICEAL SCREENING IN PATIENTS WITH CIRRHOSIS

Document Type

Conference Proceeding

Publication Date

10-1-2022

Publication Title

Hepatology

Abstract

Background: Transesophageal echocardiography (TEE) has a high safety profile with a low rate of complications (<0.5%) and mortality (<0.01%). Esophageal varices are considered a relative contraindication to TEE, therefore patients with cirrhosis are often referred to a gastroenterologist for clearance prior to TEE. However, to date there are no clear guidelines for pre-TEE evaluation. We aimed to evaluate the safety of TEEs in cirrhotic patients, particularly post-esophageal variceal banding, as well as to assess the impact of pre-TEE variceal screening endoscopy (EGD) on procedure outcomes. Methods: A single-center retrospective study was performed on cirrhotic patients who underwent a TEE between 1 1 2021 and 11 1 2021. The patient cohort was divided into two groups, a “TEE-only” group and an “EGD+TEE” group that was defined as patients receiving a screening EGD within 1 year prior to their TEE. Exclusion criteria included variceal interventions other than banding and TEEs performed intra-operatively. Outcomes studied included bleeding (hemoglobin [Hgb] drop ≥ 2 g dl and or blood transfusion within 48-hours post-TEE) and mortality. Results: Among 138 patients with cirrhosis undergoing TEEs (57% female; 74% white 22% black), 33 (24%) received a screening endoscopy prior to their TEE. Of the 33 EGD+TEE patients, 6 had prior variceal banding, with a mean duration of 51 days between banding and TEE (SD 62; range 4-155 days). Mean MELD-Na among the TEE-only and EGD+TEE groups were 19 and 21 respectively. There was no TEE mortality reported in either group. In addition, there was no statistically significant difference in all-cause mortality (P=0.848), or bleeding rates (P=0.293) between the TEE-only group and those who received a pre-TEE screening EGD (Table 1). Finally, among the EGD+TEE group there was no difference in outcomes based on the presence of esophageal varices (P=0.14), prior variceal banding (P=0.18), or the duration between variceal banding and TEE (P=0.7). Conclusion: Our study revealed that bleeding and mortality rates are not impacted by performance of variceal screening prior to TEE. These findings challenge the utility of routinely performing a pre-TEE endoscopy in all patients with cirrhosis. Future studies should focus on developing protocols to guide more targeted screening of high-risk patients with cirrhosis undergoing a TEE. (Figure Presented).

Volume

76

First Page

S1141

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