A Systematic Review of Transesophageal Echocardiography‐Induced Esophageal Perforation

Abstract

A systematic review of transesophageal echocardiography (TEE)-induced esophageal perforation was done using the MEDLINE (PubMed and OVID interfaces), Google Scholar and EMBASE databases. Thirty-five cases of esophageal perforation from 22 studies were analyzed. TEE-induced esophageal perforation occurs in elderly female patients, predominantly in an intra-operative setting. Thoracic esophagus is the most commonly involved segment, especially, when TEE is performed intra-operatively. Majority of the esophageal perforations occur in cases with a perceived low risk or smooth TEE exam and thus, screening for high risk factors may not eliminate the occurrence of a perforation. A delayed detection of perforation occurs when it is a thoracic esophageal perforation, performed intra-operatively and when there are no known preoperative risk factors. Shock during the detection of the perforation is associated with mortality. Majority of the perforations can be repaired primarily.

Transthoracic echocardiography is a safe alternative for assessment and guidance of transcatheter closure of secundum atrial septal defect in children

“…However the rational to consider TTE guidance as an alternative is driven by some rare reports of TEE-related esophageal perforation in adults and children (6)(7)(8), as well as the fact that TTE-guidance may allow to shorten both procedure time and fluoroscopy time (30) and to avoid general anesthesia and orotracheal intubation in spontaneously breathing children (30,31). Additionally, one can present the argument that in TTEguided procedures, the interventionist may be able to complete the whole process himself without the need for an additional echographist and without additional irradiation (10,30).…”

“…Trans-esophageal echocardiography (TEE) or intracardiac echocardiography (ICE) are widely used to guide the procedure (4,5). However, TEE use may lead to oropharyngeal and oesophageal traumas (6)(7)(8), and ICE is expensive and require an additional large venous access (9). Given a good echocardiographic window in children, transthoracic echocardiographic (TTE) guidance has been proposed (10)(11)(12)(13).…”

Esophageal perforation after perioperative transesophageal echocardiography: a case report

“…The incidence of iatrogenic esophageal perforation by TEE is 0.03–0.09% [5, 6]. The incidence of thoracic esophageal perforation during TEE examination is higher in the intraoperative setting than in a nonoperative setting [7]. …”

Transesophageal Monitoring in Anaesthesia: An Update

“…Metrics can be used for performance evaluation and research purposes, and is likely to transform simulation-based training in echocardiography. [76] Safety of TEE Although TEE procedures have been shown to be relatively safe with a low incidence of serious gastroesophageal injury (0.03-0.09 %), TEE-related complications are commonly associated with medicolegal litigation [77]. This is partly due to the devastating morbidity and mortality (10-56 %) caused by complications such as oesophageal perforation and partly due to the delay in diagnosis and treatment of this insidious complication [78,79].…”

“…More importantly, oesophageal perforation can even occur in patients without major risk factors or after an uncomplicated TEE procedure. The risk factors in these patients are elderly age, female sex, small stature and TEE in the operative setting [77]. Listing oesophageal perforation as a specific risk in the informed consent may limit medicolegal liability [79].…”