title: Bleeding risk in patients with esophageal varices undergoing transesophageal echocardiography.
abstract: BACKGROUND
  Bleeding from esophageal varices is a major potential concern during transesophageal echocardiography (TEE) in patients with cirrhosis of the liver. As there are limited data on its risk in these patients, this was retrospectively assessed at our institution.
  
  
  METHODS
  The hospital electronic medical record database at our university affiliated teaching hospital was searched for all patients with esophageal varices undergoing TEE from 2000 to 2012 and patient charts were reviewed for procedure-related bleeding complications.
  
  
  RESULTS
  Twenty-four patients with esophageal varices were found (18 men, 57 ± 14 years). Nine patients had grade 2 esophageal varices, 15 patients had grade 1 varices, and 12 patients had portal hypertensive gastropathy. Alcoholic liver disease (9) and hepatitis C (8) were the most common etiologies of the cirrhosis with an average MELD score of 15. The most common indication for TEE was for possible endocarditis (15). Medications potentially increasing bleeding risk included warfarin in 2 and aspirin in 7 patients. Twelve patients were taking β-blockers for portal hypertension. There were no immediate bleeding complications and none of these patients were readmitted with bleeding.
  
  
  CONCLUSIONS
  TEE can be performed without serious bleeding risk in patients with grade 1 or 2 esophageal varices.
authors.affiliation: Department of Medicine, University Hospital Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Pantham
authors.forename: Nisheet
authors.initials: N
authors.lastname: Waghray
authors.forename: Douglas
authors.initials: D
authors.lastname: Einstadter
authors.forename: Robert S
authors.initials: RS
authors.lastname: Finkelhor
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Mullen
mesh_terms: D000368:Aged; D017548:Echocardiography, Transesophageal / Q000009:adverse effects*; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000000981:diagnostic imaging*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: TEE; esophageal varices; liver cirrhosis; variceal bleeding