Findings and outcomes of emergent endoscopies after cardiovascular surgery

Abstract

Aims: Studies detailing endoscopic findings and hemostatic interventions for upper gastrointestinal bleeding after cardiovascular surgery are scarce. We conducted this study to determine the frequency and findings of emergent esophagogastroduodenoscopy (EGD) after cardiovascular surgery and the effect of bleeding requiring hemostatic intervention on clinical outcomes.

Methods and results: We retrospectively reviewed records of emergent EGD examinations conducted within 30 days after cardiovascular surgery at a tertiary referral center in Japan from April 2011 to March 2020. Of 1625 patients undergoing cardiovascular surgery, 47 underwent emergent EGD. Sources of bleeding were identified in 30 cases, including transesophageal echocardiogram (TEE)-related injuries (8 patients), gastric ulcers (7 patients), and duodenal ulcers (7 patients). Patients who required endoscopic hemostatic intervention had more TEE-related injuries (43% vs 3%, P = 0.005), gastric ulcers (35% vs 6%, P = 0.018), or ulcers in the first part of the duodenum (29% vs 0%, P = 0.006) than those who did not. Intraoperative TEE did not increase the need for endoscopic intervention (71% vs 64%, P = 0.435). Intraoperative TEE and the need for endoscopic intervention did not affect length of stay or all-cause mortality. Only one death was associated with gastrointestinal bleeding.

Conclusion: Despite the potential severity of bleeding after cardiovascular surgery, most cases can be managed endoscopically with no increase in hospital stay or mortality.

Keywords: Mallory–Weiss syndrome; heart surgery; transesophageal echocardiography; upper gastrointestinal bleeding.

Figure 1

Transesophageal echocardiography–related injury. (a) Deep, longitudinal lacerations in the upper gastric body and esophagus treated with hemoclips. Friability, mucosal discoloration, and ulceration consistent with ischemia were also observed. (b) Longitudinal hematomas, blood‐filled nasogastric tube, and longitudinal injury to the upper gastric body treated with hemoclips. While the spear‐shaped mucosal injury and esophageal findings are suggestive of traumatic transesophageal echocardiography–related injury, differentiation from Mallory–Weiss syndrome can be difficult.