title: Safety of Digestive Endoscopy following Acute Coronary Syndrome: A Systematic Review.
abstract: Background. The safety of endoscopy after an acute coronary syndrome (ACS) is poorly characterized. We thus performed a systematic review assessing the safety of endoscopy following ACS. Methods. Searches in EMBASE, Medline, and Web of Science identified articles for inclusion. Data abstraction was completed by two independent reviewers. Results. Fourteen retrospective studies yielded 1178 patients (mean 71.3 years, 59.0% male) having suffered an ACS before endoscopy. Patients underwent 1188 endoscopies primarily to investigate suspected gastrointestinal bleeding (81.2%). Overall, 810 EGDs (68.2%), 191 colonoscopies (16.1%), 100 sigmoidoscopies (8.4%), 64 PEGs (5.4%), and 22 ERCPs (1.9%) were performed 9.0 ± 5.2 days after ACS, showing principally ulcer disease (25.1%; 95% CI 22.2-28.3%) and normal findings (22.9%; 95% CI 20.1-26.0%). Overall, 108 peri- and postprocedural complications occurred (9.1%; 95% CI 7.6-10.9%), with hypotension (24.1%; 95% CI 17.0-32.9%), arrhythmias (8.1%; 95% CI 4.5-18.1%), and repeat ACS (6.5%; 95% CI 3.1-12.8%) as the most frequent. All-cause mortality was 8.1% (95% CI 6.3-10.4%), with 4 deaths attributed to endoscopy (<24 hours after ACS, 3.7% of all complications; 95% CI 1.5-9.1%). Conclusion. A significant proportion of possibly endoscopy-related negative outcomes occur following ACS. Further studies are required to better characterize indications, patient selection, and appropriate timing of endoscopy in this cohort.
authors.affiliation: Department of Internal Medicine, McGill University, Jewish General Hospital, Montreal, QC, Canada.
authors.forename: Alastair
authors.initials: A
authors.lastname: Dorreen
authors.affiliation: Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital Site, 1650 Cedar Avenue, Room D7-185, Montreal, QC, Canada H3G 1A4.
authors.forename: Sarvee
authors.initials: S
authors.lastname: Moosavi
authors.affiliation: Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital Site, 1650 Cedar Avenue, Room D7-185, Montreal, QC, Canada H3G 1A4.
authors.forename: Myriam
authors.initials: M
authors.lastname: Martel
authors.affiliation: Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital Site, 1650 Cedar Avenue, Room D7-185, Montreal, QC, Canada H3G 1A4; Epidemiology Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montreal, QC, Canada.
authors.forename: Alan N
authors.initials: AN
authors.lastname: Barkun
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000601:surgery*; D000368:Aged; D016145:Endoscopy, Digestive System / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors