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Meta-Analysis
. 2022 May;55(9):1088-1098.
doi: 10.1111/apt.16860. Epub 2022 Mar 28.

Systematic review with meta-analysis: incidence of variceal hemorrhage in patients with cirrhosis undergoing transesophageal echocardiography

Mobolaji Odewole  1   2 , Ahana Sen  1   3 , Ehiamen Okoruwa  4 , Sarah R Lieber  1 , Thomas G Cotter  1 , Anh D Nguyen  5 , Arjmand Mufti  1 , Amit G Singal  1   6 , Nicole E Rich  1   6
Affiliations
Meta-Analysis

Systematic review with meta-analysis: incidence of variceal hemorrhage in patients with cirrhosis undergoing transesophageal echocardiography

Mobolaji Odewole et al. Aliment Pharmacol Ther. 2022 May.

Abstract

Background: The presence of esophageal varices is considered a relative contraindication to transesophageal echocardiography (TEE) by cardiology professional societies, so gastroenterologists are often consulted to perform upper endoscopy prior to TEE in patients with cirrhosis.

Aim: To perform a systematic review to quantify the risk of bleeding complications in patients with cirrhosis following TEE.

Methods: Two reviewers searched Ovid MEDLINE, MEDLINE In-Process and EMBASE databases from January 1992 to May 2021 for studies reporting bleeding complications from TEE in patients with cirrhosis. We calculated the pooled incidence rate of bleeding events using the metaprop command with a random effect model.

Results: We identified 21 studies comprising 4050 unique patients with cirrhosis; 9 studies (n = 3015) assessed the risk of intraoperative TEE during liver transplant (LT) and 12 studies (n = 1035) assessed bleeding risk in patients undergoing TEE for other indications. The pooled incidence of bleeding post-TEE was 0.37% (95% CI 0.04-0.94%) across all studies. Bleeding complications were low among patients undergoing TEE during LT as well as those undergoing TEE for other diagnostic reasons (0.97% vs. 0.004%) and among studies with mean MELD >18 compared to those with mean MELD <18 (0.43% vs. 0.08%). Few studies had a comparator arm, and data on patient-level factors impacting bleeding complications (including degree of liver dysfunction and coagulopathy) were limited across studies.

Conclusions: The risk of bleeding complications following TEE is low in patients with cirrhosis, suggesting TEE is safe and risk stratification with upper endoscopy may not be necessary.

Keywords: bleeding; cardiac testing; portal hypertension; risk; varices.

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Conflict of interest statement

Conflicts of Interest: None of the authors have any conflicts of interest

Figures

Figure 1.
Figure 1.
Flow diagram for study selection
Figure 2.
Figure 2.
Incidence of bleeding in patients with cirrhosis undergoing TEE; A) intraoperatively during liver transplant and B) for other indications
See this image and copyright information in PMC

Comment in

References

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