title: Safety and utility of oesophago-gastro-duodenoscopy in acute myocardial infarction.
abstract: OBJECTIVE
  To study the safety and utility of performing an oesophago-gastro-duodenoscopy (EGD) in the setting of an acute myocardial infarction (AMI).
  
  
  METHODS
  Case records of all patients who underwent an EGD for various indications within 4 weeks of an AMI between January 2001 and April 2006 were analyzed. Demographic data, indications for endoscopy, outcomes and complications were noted. Main outcome measures included safety and utility of endoscopy in AMI.
  
  
  RESULTS
  A total of 87 EGDs were performed on 85 patients with AMI. Seventy (83%) patients had a non-ST elevation MI, whereas 15 (17%) had ST elevation MI. Mean time between EGD and AMI was 6+/-1.8 days. Indications for EGD were hematemesis and/or melena on presentation in 38 (44.7%), hematemesis and/or melena post anticoagulation in 27 (31.8%). EGD findings were gastric ulcer/erosions in 30 (34%), oesophago-gastric varices in 20 (22%), erosive oesophagitis in 17 (20%) and duodenal ulcer in 11 (13%). Diagnostic yield of EGD was 88%. Endoscopic interventions were performed in 26 (30%) patients with high risk of bleeding lesion. There were no EGD-related mortality, whereas 14 patients re-bled. A total of 21 patients died, including 7/14 (50%) who re-bled, compared with 14/71 (19%) without rebleed (P=0.008). There were no EGD-related deaths. Fourteen patients were on mechanical ventilation and 6/14 (43%) of these died as compared with 15/88 (17%) who were not ventilated (P=0.027).
  
  
  CONCLUSIONS
  EGD is safe and useful in diagnosis and management of gastrointestinal hemorrhage in patients with AMI, and allows decisions about anticoagulation. Re-bleed and need for mechanical ventilation predicts poor outcome in these patients.
authors: Section of Gastroenterology, Department of Medicine, Aga Khan University, Karachi, Pakistan.
authors: Khalid
authors: K
authors: Mumtaz
authors: Faisal Wasim
authors: FW
authors: Ismail
authors: Faisal
authors: F
authors: Wasim
authors: Wasim
authors: W
authors: Jafri
authors: Shahab
authors: S
authors: Abid
authors: Saeed
authors: S
authors: Hamid
authors: Hasnain
authors: H
authors: Shah
authors: Sajid
authors: S
authors: Dhakam
mesh_terms: D000368:Aged; D004384:Duodenoscopy / Q000009:adverse effects*; D004945:Esophagoscopy / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000601:surgery*; D005773:Gastroscopy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications*; D012008:Recurrence; D012307:Risk Factors