title: Safety of endoscopic procedures after acute myocardial infarction: a systematic review.
abstract: BACKGROUND
  The management of patients who develop gastrointestinal (GI) bleeding after acute myocardial infarction (MI) is difficult due to concerns about possible cardiovascular complications. Gastroenterologists are often reluctant to perform endoscopic procedures despite urgent indications. We performed a systematic review of the literature to determine the safety of endoscopic procedures after MI.
  
  
  METHODS
  We searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled trials for controlled clinical trials or case series examining the diagnostic efficacy and complications of esophagogastroduodenoscopy (EGD), colonoscopy and flexible sigmoidoscopy after MI. Title and abstract screening was followed by full-text review with subsequent data extraction of included studies.
  
  
  RESULTS
  A total of seven studies met inclusion criteria. Four studies evaluated safety and efficacy of EGD after MI. The reported complication rate ranged between 1-8%, with a large predominance of minor complications. We found one study addressing safety of flexible sigmoidoscopy that reported minor complications in two patients. We also identified one study addressing the safety of colonoscopy after MI, which showed a complication rate of 9%. Most of these complications were minor. A decision analysis was also included in this review.
  
  
  CONCLUSIONS
  Our review demonstrated that endoscopic procedures are safe and beneficial in stable patients with GI bleeding after recent MI and should be performed without a requisite delay. Unstable patients should undergo endoscopic procedures only in the intensive care setting, after stabilization and with close monitoring.
authors.affiliation: Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, USA.
authors.forename: Marek
authors.initials: M
authors.lastname: Cena
authors.forename: Javier
authors.initials: J
authors.lastname: Gomez
authors.forename: Tareq
authors.initials: T
authors.lastname: Alyousef
authors.forename: Richard G
authors.initials: RG
authors.lastname: Trohman
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Pierko
authors.forename: Rajender
authors.initials: R
authors.lastname: Agarwal
mesh_terms: D003661:Decision Support Techniques; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016558:Hemostasis, Endoscopic / Q000009:adverse effects; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome