Cardiovascular complications after GI endoscopy: occurrence and risks in a large hospital system

Gangi, Sumana; Saidi, Firas; Patel, Kapil; Johnstone, Barbara; Jaeger, Joseph; Shine, Daniel

doi:10.1016/s0016-5107(04)02016-4

Cited by 72 publications

(52 citation statements)

References 17 publications

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“…A team of a gastroenterologist and registered nurses has provided Propofol-based sedation with remarkable safety, excellent patient experience and without the additional cost of anesthesia personnel [28,29] . On the other hand, Gangi et al [30] , in his study, found that Propofol given by anesthesia personnel was associated with a higher complication rate. This may be due to their practice of using larger doses (for induction of the General anesthesia that is followed by assisted ventilation), whereas the endoscopy patients are expected to breathe on their own [31] .…”

Section: Specialists Is Safermentioning

confidence: 89%

Myths, fallacies and practical pearls in GI lab

Kumar¹

2014

WJGE

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Many prevalent practices and guidelines related to Gastrointestinal endoscopy and procedural sedation are at odds with the widely available scientific-physiological and clinical outcome data. In many institutions, strict policy of pre-procedural extended fasting is still rigorously enforced, despite no evidence of increased incidence of aspiration after recent oral intake prior to sedation. Supplemental oxygen administration in the setting of GI procedural sedation has been increasingly adopted as reported in the medical journals, despite clear evidence that supplemental oxygen blunts the usefulness of pulse oximetry in timely detection of sedation induced hypoventilation, leading to increased number of adverse cardiopulmonary outcomes. Use of Propofol by Gastroenterologist-Nurse team is erroneously considered dangerous and often prohibited in various institutions, at the same time worldwide reports of remarkable safety and patient satisfaction continue to be published, dating back more than a decade. Of patient monitoring practices that have been advocated to be standard, many merely add cost, not value. Advances in the technology often are not incorporated in a timely manner in guidelines or clinical practices, e.g. , Capsule endoscopy or electrocautery during GI procedures do not interfere with proper functioning of the current pacemakers or defibrillators. Orthopedic surgeons have continued to recommend prophylactic antibiotics for joint replacement patients prior to GI procedures, without any evidence of need. These myths are explored for a succint review to prompt a change in clinical practices and institutional policies. Core tip: Many prevalent endoscopic procedural practices and policies are not only unsupported by clinical and scientific evidence, but are counterproductive. Rather than enhancing patient safety and comfort, these increase risk and expense, introduce unnecessary delays. Evidence to reach proper decisions about these topics has been available for a while, but is not appropriately acknowledged and implemented. Avoiding these pitfalls can have a significant positive impact because these policies cover routine events, actions and decisions, including: required prolonged pre-procedural fasting, routine supplemental oxygen during sedation, prohibition of Propofol use by nonanesthesia personnel, multiple monitoring practices and prophylactic recommendations.Kumar P. Myths, fallacies and practical pearls in GI lab. World J Gastrointest Endosc 2014; 6(12): 584-591 Available from: URL:

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Section: Specialists Is Safermentioning

confidence: 89%

Myths, fallacies and practical pearls in GI lab

Kumar¹

2014

WJGE

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“…However, endoscopy has been shown to induce cardiovascular complications, including myocardial ischemia [40,41,54]. Thus, this practice may serve as an additional explanation for the frequent diagnosis of cardiovascular disease in patients experiencing upper gastrointesti-nal symptoms.…”

Section: Overlapping Symptomatology and Surveillancementioning

confidence: 99%

“…A second study utilizing data from 9 hospitals in the United States evaluated 602 charts for patients undergoing endoscopy and deemed to be at risk for cardiovascular disease. The researchers found an overall cardiovascular complication (either an arrhythmia, hypotension, chest pain or angina equivalent, or myocardial infarction requiring intervention and occurring within one calendar day after the endoscopy) rate of one for every 325 procedures (or 308 complications per 100,000), and a rate as high as one complication for every 94 procedures (1,063 complications per 100,000) at the worst performing hospital [41]; a complication rate 2-to 70-fold higher than previously reported in the medical literature.…”

Section: Overlapping Symptomatology and Surveillancementioning

confidence: 99%

“…Related to this, some studies have suggested that common means of investigating upper gastrointestinal symptom origin can aggravate some cardiovascular diseases or induce cardiovascular symptoms [39,40]. Finally, polypharmacy with drugs used to manage cardiovascular diseases can cause upper gastrointestinal symptoms [8,[41][42][43][44][45][46] resulting in decreased adherence to their medications, and a perhaps initiating a cycle of recurrence/worsening of cardiovascular disease. Moreover, some drugs to treat upper gastrointestinal symptoms may increase cardiovascular disease risk either directly or through drug-drug interactions.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Upper Gastrointestinal Symptoms and Cardiovascular Disease

Coleman¹,

Limone²,

Schein³

et al. 2013

Dyspepsia - Advances in Understanding and Management

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“…Questions relating to procedure assessment should be included on the board examination and should reflect a general knowledge of this content (70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85).…”

Section: Assessment Of Competencymentioning

confidence: 99%