S0533 Evaluating the Yield of EGD Performed as Clearance for TEE at Quaternary Referral Center and County Hospital

Abstract

INTRODUCTION: Hoarseness, sore throat, odynophagia, and dysphagia are the most common complications following transesophageal echocardiography (TEE), but gastrointestinal (GI) tract perforation and bleeding have also been reported. Therefore, endoscopic evaluation prior to TEE is sometimes requested, particularly in those with history of GI disease and those with ongoing GI complaints. However, there are no published guidelines and very limited studies that offer insight on when an esophagogastroduodenoscopy (EGD) is needed before TEE. METHODS: This is a multi-site retrospective chart review of patients undergoing EGD prior to TEE. CPT codes were used to identify patients who underwent EGD prior to TEE from 10/1/2010 to 10/1/2019 at a quaternary referral center and a large urban county hospital. Medical records for patients ≥ 18 years of age were queried for demographic information along with the indications and findings from EGD and TEE. The presence of cirrhosis and its associated complications were documented along with MELD and Child-Pugh (CPT) score. The patients were classified based on whether the EGD was done as clearance for TEE and those who had diagnostic EGD within one year prior to TEE. RESULTS: In the year prior to the TEE, 26.6% of the EGDs done at the county hospital and 45.7% at the quaternary referral center were requested for clearance and Table 1 shows the differences in demographics and medical history between the two groups at each site. Patients requiring clearance EGD at the referral center, were more likely to be female with a history of cirrhosis, variceal bleed, and/or CPT score (P = 0.04, 0.0012, 0.0012, and 0.0013, respectively). This difference was not seen at the county hospital. The time lapse between EGD and TEE was shorter in the clearance group at both hospitals. Figure 1 shows the most common indications for EGD at each hospital which were not significantly different between groups (P = 0.134 and 0.23). None of the patients who underwent EGD clearance for TEE had endoscopic findings that precluded TEE.Table 1Figure 1CONCLUSION: EGD prior to TEE is more likely to be requested at a large referral hospital in patients with history of cirrhosis and variceal bleeding with an advanced CPT score. Due to the retrospective nature of this study, it is possible that we did not capture a small number of patients that underwent clearance EGD, but did not undergo TEE. Nonetheless, the results of this study do not show that EGD prior to TEE changes management.