S621 GI Consultation Before TEE: A Necessary Step for Clearance in the Inpatient Setting?

Abstract

Introduction: Although esophagogastroduodenoscopy (EGD) before transesophageal echocardiogram (TEE) is common in patients with known gastrointestinal (GI) disease, there is a lack of objective evidence to support this practice. The goal of our study is to elucidate whether presence or absence of GI history and/or symptoms significantly affect the clearance for TEE. Methods: This is a retrospective cohort study performed at a tertiary care center. It included all adult patients admitted for whom an inpatient EGD was ordered and performed prior to TEE from 7/1/2008 - 4/1/2021 for the purposes of medical clearance. Data on Gastroenterology consults ordered with the indication for clearance for TEE were collected. Furthermore, indication for TEE, hospital day numbers between GI consult, EGD and TEE performance were recorded. Data was summarized using descriptive statistics and cumulative frequencies. Results: In total, 83 patients were identified. Of these, 16.9% (n=14) had no prior GI history, 31.3% (n=26) had a diagnosis of cirrhosis with or without EV, 2.4% (n=2) had a history of cirrhosis with EV with prior banding, 15.7% (n=13) had a history of dysphagia of unknown etiology, 9.6% (n=8) had a history of esophageal strictures and 24.1% (n=20) were categorized as other (Figure 1A). With regards to GI symptoms, 44.6% (n=37) had no GI symptoms, 33.7% (n=28) had dysphagia, 8.4% (n=7) had GI bleed, and 13.3% (n=11) were categorized as other (Figure 1B). The average time from admit to GI consult was 5.1 days with an average of 2.3 days from GI consult to EGD, and an average of 7.3 days from admit to EGD performance. Meanwhile, the time from admit to TEE was 9.3 days. Conclusion: The findings from this study showed that performing an EGD prior to TEE prolonged hospital stay significantly and EGD is not electively required prior to TEE. EGD did not change the management or need for TEE despite a high-risk population. Only 3 instances were identified in which a TEE was not initially performed due to inability to pass the TEE probe, prompting a GI consult. Subsequently, all 3 EGD’s were completed without complications and no contraindications to TEE were reported. Eliminating the need for EGD prior to TEE would improve hospital costs, decrease inpatient hospital nights, decrease anesthesia exposure and, finally, avoid delaying treatment plans.Figure 1.: A: GI Medical History; Legend: No GI history (16.9 %), Cirrhosis +/- EV (31.3 %), Cirrhosis with EV with prior banding (9.6 %), Dysphagia of unknown etiology (15.7 %), Esophageal strictures (2.4 %), Other (24.1%). B: Reported GI Symptoms; Legend: No GI symptoms (44.6 %), Dysphagia (33.7 %), GI bleeding (melena, hematochezia, hematemesis) (8.4 %), Other (13.3 %).