title: Safety of transesophageal echocardiography. A multicenter survey of 10,419 examinations.
abstract: BACKGROUND
  During the past few years, transesophageal echocardiography (TEE) has been increasingly used in clinical cardiology; data concerning the practicability and safety of the technique, however, are rare.
  
  
  RESULTS
  This report analyzes the experience of 15 European centers performing TEE studies for at least 1 year. At the time of this survey, 10,419 TEE examinations had been attempted or performed in these institutions. These TEE examinations were carried out by 54 physicians, 53.7% of whom had been trained in endoscopic techniques. Within the same time period, 160,431 precordial echocardiographic examinations were performed in the 15 institutions; the ratio between TEE and transthoracic studies averaged 9.03 +/- 6.4% (range of the 15 centers, 1.4-23.6%). Of the 10,419 patients, 9,240 (88.7%) were conscious inpatients or outpatients at the time of the TEE examination; the vast majority of the conscious patients did not receive intravenous sedation before TEE. In 201 cases (1.9%), insertion of the TEE probe was unsuccessfully attempted because of a lack of patient cooperation and/or operator experience (98.5%) or because of anatomical reasons (1.5%). In 90 of 10,218 TEE studies (0.88%) with successful probe insertion, the examination had to be interrupted because of the patient's intolerance of the echoscope (65 cases); because of pulmonary (eight cases), cardiac (eight cases), or bleeding complications (two cases); or for other reasons (seven cases). One of the bleeding complications resulted from a malignant lung tumor with esophageal infiltration and was fatal (mortality rate, 0.0098%).
  
  
  CONCLUSIONS
  This multicenter survey documents that TEE studies are associated with an acceptable low risk when used by experienced operators under proper safety conditions.
authors.affiliation: Division of Cardiology, Hannover Medical School, FRG.
authors.forename: W G
authors.initials: WG
authors.lastname: Daniel
authors.forename: R
authors.initials: R
authors.lastname: Erbel
authors.forename: W
authors.initials: W
authors.lastname: Kasper
authors.forename: C A
authors.initials: CA
authors.lastname: Visser
authors.forename: R
authors.initials: R
authors.lastname: Engberding
authors.forename: G R
authors.initials: GR
authors.lastname: Sutherland
authors.forename: E
authors.initials: E
authors.lastname: Grube
authors.forename: P
authors.initials: P
authors.lastname: Hanrath
authors.forename: B
authors.initials: B
authors.lastname: Maisch
authors.forename: K
authors.initials: K
authors.lastname: Dennig
mesh_terms: D003625:Data Collection; D004452:Echocardiography / Q000009:adverse effects* / Q000379:methods; D004947:Esophagus; D005060:Europe; D006761:Hospitals; D006801:Humans; D010342:Patient Acceptance of Health Care; D012307:Risk Factors; D012449:Safety