Evidence-Based Review of the Management of Cancers of the Gastroesophageal Junction

Safety and feasibility of transesophageal echocardiography in patients with prior esophageal surgery

BACKGROUND

Transesophageal echocardiography (TEE) is a specialized form of cardiac ultrasound and has been associated with rare but serious complications. In patients with prior esophageal surgery, the risk of esophageal damage or the inability to perform a comprehensive and successful TEE warrants further evaluation.

METHODS

Retrospective study of patients with prior esophageal surgery who underwent TEE between June 21, 2002 and October 15, 2019. Medical and echocardiographic records were reviewed for image quality and procedural complications. Post-procedure complications and 30-day all-cause mortality were collected. Evaluation by gastroenterology (GI), otolaryngology/ear, nose, throat (ENT), or thoracic surgery (TS) within 30 days of TEE was reviewed in detail.

RESULTS

Ninety-five patients with prior esophageal surgery underwent 145 TEEs. The most commonly performed esophageal procedures were anti-reflux operations (89%). TEE image quality was degraded in 16% while transgastric imaging was not completed in 37% of cases. A comprehensive TEE was completed in 57% of patients with diagnostic study goals achieved in 96% of cases. Comments describing procedural difficulty were reported in 6% while comments on procedural complications occurred in 1% of cases. Post-procedure complications occurred in 1% of patients including hypotension and unplanned hospital/ICU admission.

CONCLUSIONS

Concern for esophageal damage and the inability to perform a comprehensive and diagnostic TEE may limit the usefulness of TEE in patients with prior esophageal surgery. While TEE-associated complications were rare in this series, a conservative approach with a thorough pre-procedure assessment, including multi-disciplinary evaluation when appropriate, is prudent in this complex cohort of patients.