P0988 - Reconsidering the Diagnostic Yield of Routine Esophagogastroduodenoscopy Prior to Transesophageal Echocardiography in Patients With Cirrhosis

Alexander K. Malik, MD¹, Adrian S. Lindsey, MD², Emad Mansoor, MD³, Stanley M. Cohen, MD³, Gregory Cooper, MD⁴, Jaime A. Perez, PhD^5
1Summa Health System, Akron, OH; ²CWRU/UH/VA, Cleveland, OH; ³Case Western Reserve University / University Hospitals, Cleveland, OH; ⁴Case Western Reserve/UHCMC, Cleveland, OH; ⁵University Hospitals Clinical Research Center, Cleveland, OH

Introduction: Transesophageal echocardiogram (TEE) is useful for diagnosing cardiovascular disease but is considered relatively contraindicated in the presence of esophageal conditions, particularly large esophageal varices (EV) caused by cirrhosis. It is common clinical practice to request an esophagogastroduodenoscopy (EGD) prior to TEE with the rationale that pre-TEE EGD will decrease risks of subsequent variceal bleeding that may occur during TEE. We sought to evaluate the clinical utility of EGD prior to TEE in patients with cirrhosis.

Methods: We utilized TriNetX (2006-2022), a large de-identified health research network, comprising data from 80 healthcare organizations (HCOs) across the United States. We included all patients with a diagnosis of cirrhosis who underwent TEE while hospitalized. Pre-TEE EGD patients included those with cirrhosis who underwent EGD prior to TEE during the same hospitalization. The control group included patients with cirrhosis who had undergone TEE but not EGD within 3 years prior to the TEE date. The primary aim was to evaluate if pre-TEE EGD was associated with lower risks of cirrhosis-related complications at 30 days post-procedure, including variceal bleeding and mortality. The secondary aim was to evaluate the diagnostic utility of pre-TEE EGD including new diagnoses of gastric varices (GV), EV, or portal hypertensive gastropathy (PHG). Propensity score matching (PSM) was used to adjust for confounders and data was assessed using odds ratios and 95% confidence interval.

Results: Prior to PSM, 251 patients had EGD and 4,736 patients did not have EGD prior to TEE. Patients who had pre-TEE EGD were younger and less likely to be of White race compared to those without pre-TEE EGD (Table 1a).

After PSM, there were no significant demographic differences. There was no statistically significant difference in risk of new diagnosis of GV or mortality. Pre-TEE EGD patients had a statistically significant higher risk of new diagnosis of EV and PHG and higher risks of variceal bleeding and esophageal perforation (Table 1b).

Discussion: Our findings suggest reconsideration of the routine practice of performing pre-TEE EGD in all patients with cirrhosis as pre-TEE EGD was not associated with reduced risks of cirrhosis-related complications including subsequent variceal bleeding or mortality. In patients with cirrhosis who require TEE, risks of potential complications of an EGD and associated costs of an additional procedure may outweigh the clinical utility of pre-TEE EGD.



Disclosures:


Alexander K. Malik, MD¹, Adrian S. Lindsey, MD², Emad Mansoor, MD³, Stanley M. Cohen, MD³, Gregory Cooper, MD⁴, Jaime A. Perez, PhD⁵. P0988 - Reconsidering the Diagnostic Yield of Routine Esophagogastroduodenoscopy Prior to Transesophageal Echocardiography in Patients With Cirrhosis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.