P1469 - To Scope or Not to Scope? Clearance for Transesophageal Echocardiography in Cirrhotics: A Systematic Review and Meta-Analysis

Award: ACG Auxiliary Award (Trainee)
Award: Presidential Poster Award

Award: ACG Auxiliary Award (Trainee)

Award: Presidential Poster Award

Banreet Dhindsa, MD¹, Michelle Le, DO¹, Alexander Praus, MD¹, Yassin Naga, MD², syed Mohsin Saghir, MD², Harmeet Mashiana, MBBS¹, Amaninder Dhaliwal, MD³, Saurabh Chandan, MD⁴, Daryl Ramai, MD, MSc⁵, Shailender Singh, MD¹, Ishfaq Bhat, MD¹, Douglas Adler, MD^6
1University of Nebraska Medical Center, Omaha, NE; ²University of Nevada School of Medicine, Las Vegas, NV; ³University of South Florida Moffitt Cancer Center, Tampa, FL; ⁴Creighton University School of Medicine, Omaha, NE; ⁵University of Utah, Salt Lake City, UT; ⁶University of Utah School of Medicine, Salt Lake City, UT

Introduction: Transesophageal echocardiography (TEE) in patients with cirrhosis, especially patients with known history of varices, is considered to be high risk procedure among the cardiologists. Current guidelines consider the presence of esophageal varices as a relative contraindication to TEE. As a result of this, gastroenterology is consulted frequently for clearance for TEE in patients with cirrhosis. We performed a systematic review and meta-analysis on the success and adverse events of TEE in cirrhosis.



Methods: We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed, EMBASE, Web of Science databases, Google Scholar and manual search of references (from inception through May 2021) to identify the studies reporting TEE in patients with cirrhosis. The primary outcome was to evaluate the overall adverse events associated with TEE in patients with cirrhosis. The secondary outcome was to study individual adverse events associated with the procedure. The meta-analysis was performed using Der Simonian and Laird random effect model.

Results: 13 studies reporting on 1978 patients were included. Majority of the patient population were males (67.1%), with mean age of 54.6 years. 20.8% of the patients had grade 3 esophageal varices. The pooled adverse event rate was 1.23% (95% CI 0-4.83, I²=94.33). The most common adverse event was greater than 2-gram hemoglobin drop in 48 hour (0.46%; 95% CI 0-3.58, I²=94.89) and bleeding (0% ;95% CI 0-0.18, I²=0.0) respectively. No perforations were reported in our patient population. Significant heterogeneity was noted in in our meta-analysis.

Discussion: TEE is a safe procedure in patients with cirrhosis. The need for performing endoscopy prior to TEE should be reassessed given the low overall adverse events. Further randomized controlled trials should be performed to assess utility of performing endoscopy prior to TEE.



Disclosures:


Banreet Dhindsa, MD¹, Michelle Le, DO¹, Alexander Praus, MD¹, Yassin Naga, MD², syed Mohsin Saghir, MD², Harmeet Mashiana, MBBS¹, Amaninder Dhaliwal, MD³, Saurabh Chandan, MD⁴, Daryl Ramai, MD, MSc⁵, Shailender Singh, MD¹, Ishfaq Bhat, MD¹, Douglas Adler, MD⁶. P1469 - To Scope or Not to Scope? Clearance for Transesophageal Echocardiography in Cirrhotics: A Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.