Safety of Transesophageal Echocardiography in Patients with Esophageal Varices

Liu, Ellen; Guha, Avirup; Dunleavy, Michael; Obarski, Timothy P.

doi:10.1016/j.echo.2019.01.013

Cited by 12 publications

(11 citation statements)

References 5 publications

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“…We identified 21 studies comprising 4050 patients evaluating outcomes of TEE in patients with cirrhosis 19‐40 ; TEE was performed intraoperatively prior to liver transplantation in 9 studies ( n = 3015) and for other indications (e.g., cardiopulmonary evaluation or rule out infective endocarditis) in 12 studies ( n = 1035). The clinical characteristics of included studies are reported in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Systematic review with meta‐analysis: incidence of variceal hemorrhage in patients with cirrhosis undergoing transesophageal echocardiography

Odewole

Sen

Okoruwa

et al. 2022

Aliment Pharmacol Ther

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Background:The presence of esophageal varices is considered a relative contraindication to transesophageal echocardiography (TEE) by cardiology professional societies, so gastroenterologists are often consulted to perform upper endoscopy prior to TEE in patients with cirrhosis. Aim:To perform a systematic review to quantify the risk of bleeding complications in patients with cirrhosis following TEE.Methods: Two reviewers searched Ovid MEDLINE, MEDLINE In-Process and EMBASE databases from January 1992 to May 2021 for studies reporting bleeding complications from TEE in patients with cirrhosis. We calculated the pooled incidence rate of bleeding events using the metaprop command with a random effect model. Results:We identified 21 studies comprising 4050 unique patients with cirrhosis; 9 studies (n = 3015) assessed the risk of intraoperative TEE during liver transplant (LT) and 12 studies (n = 1035) assessed bleeding risk in patients undergoing TEE for other indications. The pooled incidence of bleeding post-TEE was 0.37% (95% CI 0.04-0.94%) across all studies. Bleeding complications were low among patients undergoing TEE during LT as well as those undergoing TEE for other diagnostic reasons (0.97% vs. 0.004%) and among studies with mean MELD >18 compared to those with mean MELD <18 (0.43% vs. 0.08%). Few studies had a comparator arm, and data on patient-level factors impacting bleeding complications (including degree of liver dysfunction and coagulopathy) were limited across studies. Conclusions:The risk of bleeding complications following TEE is low in patients with cirrhosis, suggesting TEE is safe and risk stratification with upper endoscopy may not be necessary.

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Section: Resultsmentioning

confidence: 99%

Systematic review with meta‐analysis: incidence of variceal hemorrhage in patients with cirrhosis undergoing transesophageal echocardiography

Odewole

Sen

Okoruwa

et al. 2022

Aliment Pharmacol Ther

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“…This increased mortality should be weighed against the risks induced by routine TEE. Some studies have shown that serious complications of the performance of TEE is around 0.1% [ 13 , 14 , 15 ]. However, these studies are old and generally limited to special risk situation, such as esophageal varices [ 15 ] or thrombocytopenia [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…Some studies have shown that serious complications of the performance of TEE is around 0.1% [ 13 , 14 , 15 ]. However, these studies are old and generally limited to special risk situation, such as esophageal varices [ 15 ] or thrombocytopenia [ 16 ]. The rate of serious complications in other scenarios is probably lower.…”

Section: Introductionmentioning

confidence: 99%

Unreliability of Clinical Prediction Rules to Exclude without Echocardiography Infective Endocarditis in Staphylococcus aureus Bacteremia

Calderón-Parra

Diego-Yagüe

Santamarina-Alcantud

et al. 2022

JCM

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Background: It is unclear whether the use of clinical prediction rules is sufficient to rule out infective endocarditis (IE) in patients with Staphylococcus aureus bacteremia (SAB) without an echocardiogram evaluation, either transthoracic (TTE) and/or transesophageal (TEE). Our primary purpose was to test the usefulness of PREDICT, POSITIVE, and VIRSTA scores to rule out IE without echocardiography. Our secondary purpose was to evaluate whether not performing an echocardiogram evaluation is associated with higher mortality. Methods: We conducted a unicentric retrospective cohort including all patients with a first SAB episode from January 2015 to December 2020. IE was defined according to modified Duke criteria. We predefined threshold cutoff points to consider that IE was ruled out by means of the mentioned scores. To assess 30-day mortality, we used a multivariable regression model considering performing an echocardiogram as covariate. Results: Out of 404 patients, IE was diagnosed in 50 (12.4%). Prevalence of IE within patients with negative PREDICT, POSITIVE, and VIRSTA scores was: 3.6% (95% CI 0.1–6.9%), 4.9% (95% CI 2.2–7.7%), and 2.2% (95% CI 0.2–4.3%), respectively. Patients with negative VIRSTA and negative TTE had an IE prevalence of 0.9% (95% CI 0–2.8%). Performing an echocardiogram was independently associated with lower 30-day mortality (OR 0.24 95% CI 0.10–0.54, p = 0.001). Conclusion: PREDICT and POSITIVE scores were not sufficient to rule out IE without TEE. In patients with negative VIRSTA score, it was doubtful if IE could be discarded with a negative TTE. Not performing an echocardiogram was associated with worse outcomes, which might be related to presence of occult IE. Further studies are needed to assess the usefulness of clinical prediction rules in avoiding echocardiographic evaluation in SAB patients.

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“…However, this increased mortality should be weighed against the risks induced by routine TEE. Several studies have shown that serious complications of the performance of TEE is around 0.1%, in addition to the economic and personnel costs involved (10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

The Use of Clinical Prediction Rules without Echocardiographic Evaluation in Staphylococcus aureus bacteraemia may not be Enough to Exclude Infective Endocarditis and be Associated with Increased Mortality

Calderón-Parra¹,

Diego-Yagüe²,

Santamarina-Alcantud³

et al. 2022

Preprint

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Background. It is unclear whether the use of clinical prediction rules is sufficient to rule out infective endocarditis (IE) in patients with Staphylococcus aureus bacteremia (SAB) without an echocardiogram evaluation, either transthoracic (TTE) and/or transesophageal (TEE). Our primary purpose was to test the usefulness of PREDICT, POSITIVE and VIRSTA scores to rule out IE without echocardiography. Our secondary purpose was to evaluate whether not performing an echocardiogram evaluation is associated with higher mortality. Methods. We conducted a unicentric retrospective cohort including all patients with a first SAB episode from January 2015 to December 2020. IE was defined according to modified Duke criteria. We predefined threshold cut-off points to consider that IE was ruled out by means of the mentioned scores. To assess 30-day mortality, we used a multivariable regression model considering performing an echocardiogram as covariate. Results. Out of 404 patients, IE was diagnosed in 50 (12.4%). Prevalence of IE within patients with negative PREDICT, POSITIVE and VIRSTA scores was: 3.6% (95% CI 0.1-6.9%), 4.9% (95% CI 2.2-7.7%), and 2.2% (95% CI 0.2-4.3%), respectively. Patients with negative VIRSTA and negative TTE had an IE prevalence of 0.9% (95% CI 0-2.8%). Performing an echocardiogram was independently associated with lower 30-day mortality (OR 0.24 95%CI 0.10-0.54, p=0.001). Conclusion. PREDICT and POSITIVE scores were not sufficient to rule out IE without TEE. In patients with negative VIRSTA score, it was doubtful if IE could be discarded with a negative TTE. Not performing an echocardiogram was associated with worse outcomes, which might be related to presence of occult IE. Further studies are needed to assess the usefulness of clinical prediction rules in avoiding echocardiographic evaluation in SAB patients.

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Safety of Transesophageal Echocardiography in Patients with Esophageal Varices

Cited by 12 publications

References 5 publications

Systematic review with meta‐analysis: incidence of variceal hemorrhage in patients with cirrhosis undergoing transesophageal echocardiography

Systematic review with meta‐analysis: incidence of variceal hemorrhage in patients with cirrhosis undergoing transesophageal echocardiography

Unreliability of Clinical Prediction Rules to Exclude without Echocardiography Infective Endocarditis in Staphylococcus aureus Bacteremia

The Use of Clinical Prediction Rules without Echocardiographic Evaluation in Staphylococcus aureus bacteraemia may not be Enough to Exclude Infective Endocarditis and be Associated with Increased Mortality

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