S1225 Assessing the Clinical Yield of Pre-Procedural EGD Prior to Transesophageal Echocardiography in Patients Without Cirrhosis

Introduction: Esophagogastroduodenoscopy (EGD) is occasionally performed prior to transesophageal echocardiography (TEE) to evaluate for esophageal pathology; however, data assessing the utility of this practice in non-cirrhotic patients is limited. We aimed to evaluate whether pre-TEE EGD findings influenced TEE timing, procedural safety, TEE complications, or clinical decision-making. Methods: We conducted a retrospective review of 114 non-cirrhotic patients who underwent EGD prior to scheduled TEE. Demographic data, EGD indications, findings, and interventions were recorded. Primary outcomes included delay in TEE attributable to EGD findings. Secondary outcomes included rate of significant findings, frequency of interventions performed, and TEE complications. Results: Among 114 patients (63% male, mean body mass index 29.2 ± 9.4), the most common indications for EGD included gastrointestinal bleeding (n = 26), iron deficiency anemia (n = 24), and routine pre-TEE clearance (n = 25). Significant esophageal findings were noted in 21 patients: ulcers (n = 10), esophagitis (n = 8), and strictures (n = 3). Interventions beyond biopsy were performed in 13 patients (11.4%), with only 4 (3.5%) requiring intra-esophageal therapy (e.g., dilation, hemostasis). Despite the low rate of actionable findings, TEE was delayed in 13 cases (11.4%) due to pending EGD clearance. Two TEE-related complications were recorded: 1 case of non-sustained ventricular tachycardia (NSVT) and 1 case of heart block. These occurred in patients with EGD findings of Barrett’s esophagus and a duodenal polyp, respectively—neither of which would have prevented the complications. No EGD findings led to cancellation or alteration of TEE, and no EGD-related complications or mortality occurred. Conclusion: Pre-procedural EGD in non-cirrhotic patients undergoing TEE demonstrates low diagnostic and therapeutic yield. Only 11.4% of patients required any intervention, and esophageal pathology was infrequent. EGD findings did not alter TEE plans but caused procedural delays in over 10% of cases. While 2 TEE-related complications occurred, they were unrelated to and not preventable by EGD findings. These data suggest EGD is overutilized in this setting and should be reserved for patients with clear esophageal symptoms or risk factors.