Cardiopulmonary compromise during and after gastrointestinal endoscopy

ABSTRACT

Although gastrointestinal endoscopy is a safe procedure, it is occasionally associated with complications especially in elderly patients or those having heart disease. We studied some cardiopulmonary parameters during and after upper gastrointestinal endoscopy and colonoscopy in patients with and without heart disease in different age groups. Ninety hospitalized patients with age range [46-94 years]; all underwent endoscopy without premedications or conscious sedation. Patients were classified into three groups according to age and risk cardiac index. Electrocardiography with two leads [II, V5] was used; blood pressure and peripheral oxygen saturation [SpO2] were monitored throughout the procedure. Troponin t was evaluated before and 12 hours after the procedure. Relation between changes in cardiopulmonary parameters during and after endoscopy and cardiac function were analyzed. A significant fall was noted in SpO2 during the procedure in group II [92.12 +/- 3.4] and group III [91. 75 +/- 2.4] [P= 0.001] whereas in group I [95 .34 +/- 1.1] no significant fall in SpO2 was noted from the baseline [P=0.63]. A higher cardiac risk index was found in patients with oxygen desaturation than in patients without it [P<0.05]. Atrial and ventricular premature beats found to be significantly higher in old patients and those had underlying heart disease. There is significant increase in systolic blood pressure during insertion of endoscope in all groups with no statistical difference between groups [P=0.5]. ST changes were recorded in three patients with no significant ST level changes between patients with and without heart diseases. Silent ischemia was reported as elevated Troponin t in three patients. Duration of the procedure significantly correlated with oxygen desaturation. Transient cardiopulmonary changes are not uncommon during upper and lower gastrointestinal endoscopy. Patients with ischemic heart disease, chronic pulmonary disease, advanced age, and those undergoing prolonged therapeutic procedures must be considered as high risk patients for the development of cardiopulmonary complications during gastrointestinal endoscopy. Routine use of electronic monitoring with pulse oximetry, ECG recording and blood pressure are important for detecting potentially important abnormalities in high risk groups