Nadia Huq, MD1, Dereje Siyum, MD1, Ahmed Akhter, MD1, Maharaj Singh, PhD2, Patrick Pfau, MD3, Deepak Gopal, MD, FRCP(C), FACG3; 1Advocate Aurora Healthcare, Milwaukee, WI; 2Aurora Research Institute, Milwaukee, WI; 3University of Wisconsin School of Medicine & Public Health, Madison, WI
Introduction: Endoscopy is often requested prior to left heart catheterization(LHC) although the incidence and utility of endoscopic evaluation pre-LHC has not been reported. The goal of our quality study is to examine current practices of endoscopic evaluation prior to left heart catheterization and its impact on gastrointestinal bleeding for patients post-heart catheterization as compared to those who did not have endoscopic evaluation pre-cardiac catheterization. Methods: Patients who underwent LHC and endoscopic evaluation as identified by CPT coding within 30 days prior to LHC were identified between 01/01/2012 and 12/31/2019. Chart review of patients post-LHC were followed up to a year for any further endoscopic evaluation(s). Indication and average time to endoscopy were reported using descriptive statistics in patients who had previously underwent pre-LHC endoscopic evaluation. Results: 29,991 patients had LHC of which 274 patients had 333 endoscopic evaluations within 30 days prior to LHC. 181(54%) completed esophagogastroduodenoscopies, 134 (40%) completed colonoscopies, 10 (3%) completed sigmoidoscopies, 8 (2.4%) completed small bowel procedures(either push enteroscopy, capsule endoscopy or double balloon enteroscopy). 18% of patients who underwent endoscopic evaluation prior to LHC also had endoscopy up to one year (366 days maximum) post-LHC. Patients who underwent endoscopy 30 days-pre and 1 year-post-LHC had the following indications post-LHC: anemia(N=8, 17%), rectal bleeding (N=6, 12.5%), screening colonoscopies(N=9, 18.8%), melena or hematemesis(N=4, 8.3%), history of cirrhosis/variceal screening (N=7, 14.6% ), abdominal pain(N=7, 14.6%), nausea/vomiting(N=3, 6.3%), IBD related screening or diarrhea(N=6, 12.5%), abnormal CT(N=2, 4.2%), and history of PUD (N=4, 8.3%). The average time to endoscopy post-LHC regardless of pre-LHC endoscopy was 174 days (minimum 1 day, max 366 days). In patients who had undergone endoscopy within 30 days prior to LHC and up to 1 year after LHC with history of GIB the average time to post-cath endoscopy was 153.9 days versus 155.2 days in those who had not undergone pre-cath endoscopy(p=0.86). Discussion: There was no difference in timing to endoscopy post-LHC between patients who had undergone pre-LHC endoscopic evaluation versus those who did not. Endoscopic evaluation prior to LHC does not seem to affect the need for endoscopic evaluation post-LHC. Further prospective studies are needed to validate this finding.
Disclosures: Nadia Huq indicated no relevant financial relationships. Dereje Siyum indicated no relevant financial relationships. Ahmed Akhter indicated no relevant financial relationships. Maharaj Singh indicated no relevant financial relationships. Patrick Pfau indicated no relevant financial relationships. Deepak Gopal indicated no relevant financial relationships.