Geisinger Wyoming Valley Medical Center Wilkes-Barre, PA
Manesh Kumar Gangwani, MD1, Umar Hayat, MD2, Rehmat Ullah Awan, MD3, Abeer Aziz, MD4, Dushyant Singh. Dahiya, MD5, Muhammad Aziz, MD1, Wade M.. Lee-Smith, MLS1, Hajera Amantul-Raheem, 6, Yusuf Nawras, 1, Faisal Kamal, MD7, Sumant Inamdar, MD8 1University of Toledo, Toledo, OH; 2Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA; 3Ochsner Rush Medical Center, Meridian, MS; 4University of Augusta, Augusta, GA; 5University of Kansas School of Medicine, Kansas City, KS; 6Deccan College of Medical Sciences, Toledo, OH; 7Thomas Jefferson Health, Philadephia, PA; 8University of Arkansas, Toledo, OH
Introduction:
Transesophageal echocardiography (TEE) is a growing modality that plays a significant role in guiding clinical decision-making. However, upper gastrointestinal (GI) injuries are frequently observed as complications of TEE. The objective of this study is to systematically review the incidence rates and different types of GI injuries associated with TEE.
Methods: A comprehensive literature search was performed across multiple databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, and the Global Index Medicus. The search utilized specific keywords related to "TEE" and "GI injuries". Pooled rates were calculated for overall injuries, GI complications, lacerations, and perforations, with corresponding 95% confidence intervals (CI). Additionally, a subgroup analysis was conducted using odds ratios (OR) to compare bleeding rates between the variceal and non-variceal groups.
Results: A total of 1,151 articles were evaluated, and 26 studies with 55,319 patients were included in the analysis. The overall rate of adverse events was found to be 0.51% with a 95% confidence interval (CI) of 0.3% to 0.7%. Among all adverse events, bleeding was the most commonly reported, followed by dysphagia and lacerations (refer to Table 1 for details). The highest rates of adverse events were observed in liver transplant patients at 1.35%, followed by critically ill patients in the intensive care unit (ICU) and in-hospital settings at 1.1%. Adverse events during intraoperative TEE were noted at a rate of 0.7%, while patients undergoing cardiac procedures experienced adverse events at a rate of 0.67%.
The pooled complication rate for bleeding was calculated to be 0.17% with a 95% CI of 0.1% to 0.3%. The rate of odynophagia/dysphagia was estimated to be 0.27% with a 95% CI of -0.1% to 0.5%, and lacerations had a rate of 0.12% with a 95% CI of -0.1% to 0.5%. A subgroup analysis comparing variceal and non-variceal cohorts across three studies revealed no significant difference in bleeding rates.
Discussion: Our review documented the complications associated with TEE and their correlation with different patient subgroups. Our study demonstrates benefits of TEE outweigh the minimal risks involved in at-risk patients including those with varices. Further studies are needed to validate our findings and provide valuable insights for future clinical decision-making.
Figure: Forest plot comparing variceal vs non-variceal bleed rates.
Disclosures:
Manesh Kumar Gangwani indicated no relevant financial relationships.
Umar Hayat indicated no relevant financial relationships.
Rehmat Ullah Awan indicated no relevant financial relationships.
Abeer Aziz indicated no relevant financial relationships.
Dushyant Dahiya indicated no relevant financial relationships.
Muhammad Aziz indicated no relevant financial relationships.
Wade Lee-Smith indicated no relevant financial relationships.
Hajera Amantul-Raheem indicated no relevant financial relationships.
Yusuf Nawras indicated no relevant financial relationships.
Faisal Kamal indicated no relevant financial relationships.
Sumant Inamdar indicated no relevant financial relationships.
Manesh Kumar Gangwani, MD1, Umar Hayat, MD2, Rehmat Ullah Awan, MD3, Abeer Aziz, MD4, Dushyant Singh. Dahiya, MD5, Muhammad Aziz, MD1, Wade M.. Lee-Smith, MLS1, Hajera Amantul-Raheem, 6, Yusuf Nawras, 1, Faisal Kamal, MD7, Sumant Inamdar, MD8. P1969 - Transesophageal Echo Associated Gastrointestinal Injuries: A Pooled Rate of Injuries, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
