To TOE or not to TOE? That is the question in patients with portal hypertension and varices: Table 1

Leung, Christopher; Yeoh, Sern Wei; Lim, Lucy; Boyapati, Ray; Testro, Adam; Vaughan, Rhys; Marion, Kaye; Burrell, Louise M.; Angus, Peter W

doi:10.1136/gutjnl-2012-303351

Cited by 3 publications

(4 citation statements)

References 7 publications

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“…NAFLD is the most common cause of cryptogenic cirrhosis[ 8 ]. Occasionally, NAFLD can progress to hepatocellular carcinoma skipping cirrhosis interval[ 9 ]. NAFLD was first reported in 1980 by Ludwig et al[ 10 ] who described histological findings in 20 patients, mostly obese, with NAFLD.…”

Section: Introductionmentioning

confidence: 99%

Fatty liver without a large “belly”: Magnified review of non-alcoholic fatty liver disease in non-obese patients

Yousef

Juboori

Albarrak

et al. 2017

WJGP

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Nonalcoholic fatty liver disease (NAFLD) is well described as a common cause of chronic liver disease, mostly in the obese population. It refers to a spectrum of chronic liver disease that starts with simple steatosis than progresses to nonalcoholic steatohepatitis and cirrhosis in patients without significant alcohol consumption. NAFLD in the non-obese population has been increasingly reported and studied recently. The pathogenesis of nonobese NAFLD is poorly understood and is related to genetic predisposition, most notably patatin-like phospholipase domain-containing 33 G allele polymorphism that leads to intrahepatic triglyceride accumulation and insulin resistance. Non-obese NAFLD is associated with components of metabolic syndrome and, especially, visceral obesity which seems to be an important etiological factor in this group. Dietary factors and, specifically, a high fructose diet seem to play a role. Cardiovascular events remain the main cause of mortality and morbidity in NAFLD, including in the non-obese population. There is not enough data regarding treatment in non-obese NAFLD patients, but similar to NAFLD in obese subjects, lifestyle changes that include dietary modification, physical activity, and weight loss remain the mainstay of treatment.

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Section: Introductionmentioning

confidence: 99%

Fatty liver without a large “belly”: Magnified review of non-alcoholic fatty liver disease in non-obese patients

Yousef

Juboori

Albarrak

et al. 2017

WJGP

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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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“…Recent data have suggested that patients who undergo TEE actually have an extremely low incidence of bleeding. 3,[7][8][9][10][11][12][13][14][15][16][17][18] The incidence of major bleeding with diagnostic TEE has been reported to occur in less than 0.01% of cases. 4 This has led some to question the significance of the theoretical risk of mechanical trauma.…”

Section: Introductionmentioning

confidence: 99%

“…However, there has been no consistent data to suggest variceal‐related complications from performing TEE. Recent data have suggested that patients who undergo TEE actually have an extremely low incidence of bleeding 3,7–18 . The incidence of major bleeding with diagnostic TEE has been reported to occur in less than 0.01% of cases 4 .…”

Section: Introductionmentioning

confidence: 99%

Role of endoscopic evaluation prior to diagnostic transesophageal echocardiography: Is it necessary?

et al. 2022

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Background and Aim Esophagogastroduodenoscopy (EGD) is often performed prior to transesophageal echocardiogram (TEE) to evaluate for esophageal pathologies. Although TEE is a safe procedure, some contraindications exist, such as esophageal varices. The incidence of bleeding with TEE is <0.01%, which questions the need for this routine invasive procedure prior to TEE. We sought to characterize patients in whom pre‐TEE endoscopy was requested to determine its clinical utility and identify those that would most benefit. Methods We retrospectively studied patients who underwent EGD for TEE clearance between January 2014 and October 2019. We assessed how often EGD changed management and complications after TEE in those with EGD abnormalities. Results Eighty‐three patients were included. Twenty‐three percent had prior GI bleed, 63% had cirrhosis, 18% had known varices, and 7% had prior variceal bleed. The most common EGD findings were varices (33%). Eighty‐one percent proceeded with TEE. Reasons for TEE deferral included varices (12.5%), high‐risk bleeding lesion (12.5%), and mechanical abnormality (12.5%). In the majority (37.5%), TEE was deemed no longer indicated. No patient undergoing TEE had significant hemoglobin drop or overt bleeding. The most common reason for not performing TEE was unrelated to EGD findings: lack of ongoing indication for TEE. Conclusion Based on our study, EGD is likely not needed for TEE clearance in patients with varices or prior GI bleed. Given that data are limited in patients with abnormalities such as strictures, EGD may still be warranted for these patients. Further studies to identify which patients will benefit from pre‐TEE endoscopy are warranted.

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To TOE or not to TOE? That is the question in patients with portal hypertension and varices: Table 1

Cited by 3 publications

References 7 publications

Fatty liver without a large “belly”: Magnified review of non-alcoholic fatty liver disease in non-obese patients

Fatty liver without a large “belly”: Magnified review of non-alcoholic fatty liver disease in non-obese patients

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

Role of endoscopic evaluation prior to diagnostic transesophageal echocardiography: Is it necessary?

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