Troponin T after endoscopic retrograde cholangiopancreatography: no evidence of harm.
OBJECTIVE
It is well recognized that myocardial ischemia can occur during endoscopic retrograde cholangiopancreatography (ERCP). Acute arrhythmias and ST segment changes have been reported by a number of authors, but the longer-term sequelae with regard to permanent myocardial damage are not known. The aim of this study was to determine the presence or absence of significant injury to the heart muscle.


METHODS
Sixty-two patients undergoing therapeutic ERCP were assessed clinically and with electrocardiography (ECG) for the presence of ischemic heart disease before the procedure. Extensive intraprocedural monitoring was carried out, postprocedural ECGs were recorded, and serum troponin T levels were measured. The ECGs were evaluated blindly by a single cardiologist.


RESULTS
In 61 of the 62 patients, no changes were observed between the ECGs before and after the procedure. One patient had postprocedural T wave inversion but a normal troponin T level, excluding myocardial damage. One patient with mild renal insufficiency and treated heart failure had borderline troponin T elevation (0.05 microg/l) but no ECG changes. No complications of ERCP occurred.


CONCLUSIONS
Whilst ECG and rhythm changes indicating transient myocardial ischemia do occur during ERCP, there is no evidence that myocardial damage takes place as a consequence of this.
Martin
D F
DF
Academic Deparment of Gastrointestinal Radiology, South Manchester University Hospitals, Manchester, United Kingdom. derrick.martin@smtr.nhs.uk
Laasch
H-U
HU
Kelly
A-M
AM
Hammonds
R
R
Wilbraham
L
L
Sastry
S
S
England
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D020107:Troponin T