Safety of Endoscopy After Myocardial Infarction Based on Cardiovascular Risk Categories

Spier, Bret J.; Said, Adnan; Moncher, Karen; Pfau, Patrick R.

doi:10.1097/01.mcg.0000225624.91791.fa

Cited by 22 publications

(5 citation statements)

References 18 publications

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“…We suspect that this may be related to concerns from clinicians that the risks of the EGD may outweigh the benefit in these populations, in spite of the overall low complication rate of 0.5 % [26–28]. Further, several studies have suggested that EGD performed for active bleeding within 30 days of myocardial infarction can be completed safely without significant added risk [29, 30]. Conversely, these groups of patients may be the least likely to tolerate an EVB due to their underlying cardiac and respiratory disease and consequently may derive more benefit from the prevention of an EVB then those with normal cardiac and lung function.…”

Section: Discussionmentioning

confidence: 99%

Facility- and Patient-Level Factors Associated with Esophageal Variceal Screening in the USA

et al. 2015

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Background and Aim The American Association for the Study of Liver Disease (AASLD) recommends screening for esophageal varices (EV) by esophagoduodenoscopy (EGD) in patients with cirrhosis to guide decisions regarding primary prophylaxis for EV hemorrhage. We aimed to identify patient and facility factors associated with EV screening in veterans with hepatitis C (HCV)-associated cirrhosis. Methods This was a population-based cohort study. Veterans with HCV and newly diagnosed cirrhosis between 1/1/2004 and 12/31/2005 and followed until 12/31/2011 were included. The primary outcome was receipt of EGD within 1 year of cirrhosis diagnosis. Patient- and facility-level factors associated with EV screening were determined. Results A total of 4230 patients with HCV cirrhosis were identified. During median follow-up of 6.1 years (IQR: 4.0–8.0), 21.5 % developed a decompensating event, and 38.3 % died. Fifty-four percent received an EGD, and 33.8 % had an EGD within guidelines. Median time from cirrhosis diagnosis to EGD was 72 days (IQR: 12–176). Factors independently associated with receipt of EV screening were a decompensation event (OR 1.16, CI 1.01–1.32) and gastroenterology/hepatology clinic access (OR 2.1, CI 1.73–2.46), whereas cardiovascular (OR 0.81, CI 0.69–0.95), mental health (OR 0.79, CI 0.68–0.91), and respiratory (OR 0.85, CI 0.72–0.99) comorbidities were associated with reduced likelihood of EV screening. Conclusion EV screening per AASLD guidelines occurs in only one-third of patients. This missed opportunity was strongly associated with access to gastroenterology/hepatology specialty care. Additionally, providers may be relying on clinical cues (i.e., decompensation) to prompt referral for endoscopy suggesting education to improve compliance with guidelines is needed.

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Section: Discussionmentioning

confidence: 99%

Facility- and Patient-Level Factors Associated with Esophageal Variceal Screening in the USA

et al. 2015

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“…The important issue of elapsed time between the ACS and endoscopy with regard to incidence of complications was only assessed in one study. Indeed, Spier et al noted an inverse relationship between endoscopic complications from timing of ACS; in 135 patients, the only 2 complications occurred with endoscopy performed the same day as ACS, in contrast to no complications in procedures performed 24 hours or more after an ACS [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“… “x”: not reported. ENDO: data from two publications: Spier et al [ 8 ]and Sayana et al [ 15 ], in which several endoscopic modalities were used. …”

Section: Figurementioning

confidence: 99%

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Safety of Digestive Endoscopy following Acute Coronary Syndrome: A Systematic Review

Dorreen

Moosavi

Martel

et al. 2016

Canadian Journal of Gastroenterology and Hepatology

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Background. The safety of endoscopy after an acute coronary syndrome (ACS) is poorly characterized. We thus performed a systematic review assessing the safety of endoscopy following ACS. Methods. Searches in EMBASE, Medline, and Web of Science identified articles for inclusion. Data abstraction was completed by two independent reviewers. Results. Fourteen retrospective studies yielded 1178 patients (mean 71.3 years, 59.0% male) having suffered an ACS before endoscopy. Patients underwent 1188 endoscopies primarily to investigate suspected gastrointestinal bleeding (81.2%). Overall, 810 EGDs (68.2%), 191 colonoscopies (16.1%), 100 sigmoidoscopies (8.4%), 64 PEGs (5.4%), and 22 ERCPs (1.9%) were performed 9.0 ± 5.2 days after ACS, showing principally ulcer disease (25.1%; 95% CI 22.2–28.3%) and normal findings (22.9%; 95% CI 20.1–26.0%). Overall, 108 peri- and postprocedural complications occurred (9.1%; 95% CI 7.6–10.9%), with hypotension (24.1%; 95% CI 17.0–32.9%), arrhythmias (8.1%; 95% CI 4.5–18.1%), and repeat ACS (6.5%; 95% CI 3.1–12.8%) as the most frequent. All-cause mortality was 8.1% (95% CI 6.3–10.4%), with 4 deaths attributed to endoscopy (<24 hours after ACS, 3.7% of all complications; 95% CI 1.5–9.1%). Conclusion. A significant proportion of possibly endoscopy-related negative outcomes occur following ACS. Further studies are required to better characterize indications, patient selection, and appropriate timing of endoscopy in this cohort.

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“…Therapeutic ERCP has been shown to lead to less mortality and morbidity than surgery. Although upper gastrointestinal endoscopy and colonoscopy are relatively safe procedures after myocardial infarction (MI),4–8 ERCP is considered as a high-risk procedure after acute coronary syndrome (ACS) 9–11. ERCP has greater cardiovascular risks than any other endoscopic procedures because of longer procedure time, more anesthetic medications, frequent underlying cholangitis, and frequent need for therapeutic ERCP 12.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Retrograde Cholangiopancreatography in Patients with Previous Acute Coronary Syndrome

et al. 2014

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Background/AimsEndoscopic retrograde cholangiopancreatography (ERCP) is considered a high-risk procedure in patients with previous acute coronary syndrome (ACS); however, clinical studies are rare in the literature. The aim of this study was to investigate the safety and efficacy of ERCP in patients with previous ACS.MethodsWe retrospectively reviewed the medical records of patients with previous ACS who underwent ERCP between January 2007 and August 2012. The clinical characteristics, ERCP diagnoses, treatment results, and complications were analyzed.ResultsFifty patients underwent ERCP an average of 41.6 months after ACS. The most common indication for ERCP was calculous cholangitis. After deep biliary cannulation, endoscopic sphincterotomy, biliary stone removal and endoscopic biliary drainage were successfully performed. Immediate postsphincterotomy bleeding occurred in seven patients, which was successfully controlled using endoscopic therapy. Elevation of cardiac troponin I levels were observed in three patients (6%) before ERCP, and all of these patients were diagnosed with pancreatobiliary disease combined with recurrent ACS, which was treated with coronary artery stent insertion (n=2) and balloon angioplasty (n=1).ConclusionsTherapeutic ERCP is effective and safe in patients with previous ACS. Cardiac troponin I elevation should be considered a warning sign for recurrent ACS in patients who undergo ERCP.

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Safety of Endoscopy After Myocardial Infarction Based on Cardiovascular Risk Categories

Cited by 22 publications

References 18 publications

Facility- and Patient-Level Factors Associated with Esophageal Variceal Screening in the USA

Facility- and Patient-Level Factors Associated with Esophageal Variceal Screening in the USA

Safety of Digestive Endoscopy following Acute Coronary Syndrome: A Systematic Review

Endoscopic Retrograde Cholangiopancreatography in Patients with Previous Acute Coronary Syndrome

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