Does an Upper Endoscopy Before Transesophageal Echocardiography Change Patient Management?
OBJECTIVE
To determine if esophagogastroduodenoscopy (EGD) before transesophageal echocardiography (TEE) will change patient management.


BACKGROUND
Before TEE gastroenterologists are often consulted to evaluate patients with a history of dysphagia, known gastrointestinal (GI) disease, or GI bleed. There are no known published data on the clinical utility of EGD before TEE.


METHODS
Retrospective study at an inner city tertiary-care center.


METHODS
A total of 134 patients were included who were at least 18 years old and underwent an EGD to evaluate the safety of the blind passage of a TEE probe.


RESULTS
In total, 134 patients were identified. Twenty patients (15%) were not cleared for TEE due to esophageal surface abnormalities (n=3; esophagitis, ulcer, mucosal tear), esophageal structural abnormalities (n=10; varices, stricture, ring, web, hernia, Zenker), and combinations thereof (n=7). Of the 20 patients not cleared for TEE, 17 never underwent a TEE and 3 patients underwent a TEE 7 to 180 days later. Two patients undergoing EGD and 5 patients undergoing TEE experienced adverse cardiopulmonary events.


CONCLUSIONS
Our results demonstrate that an EGD before TEE can elucidate findings that may preclude the passage of a blind probe in patients with upper GI symptoms or known esophageal disease. Therefore, we propose that an EGD is clinically beneficial before TEE and can change patient management.
*Division of Gastroenterology and Hepatology, Drexel University College of Medicine, Philadelphia, PA †Department of Internal Medicine, University of Maryland, College Park, MD.
Tobias
T
Zuchelli
Eva
E
Alsheik
Christopher
C
Chu
Bhavik
B
Bhandari
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology; D017548:Echocardiography, Transesophageal / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D004935:Esophageal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult