S1229 Safety of Endoscopy in the Cocaine-Using Patient

Introduction: Cocaine is the second most used recreational drug in the United States after marijuana. Its autonomic nervous system effects are believed to increase the risk of cardiovascular and pulmonary complications during endoscopic procedures. Peri-operative cocaine use, while described in the surgical and anesthesiology literature, is limited within the field of gastroenterology. To date, there are no society guidelines regarding the optimal approach to performing esophagogastroduodenoscopy (EGD) and/or colonoscopy in patients found to be positive for cocaine use in the pre-operative setting. The aim of this study was to compare peri-procedural cardiopulmonary adverse events between acute, remote, and non-users of cocaine undergoing EGD and/or colonoscopy. Methods: In total, 130 patients underwent EGD and/or colonoscopy at Loyola University Medical Center, Maywood, Illinois between January 2012 to December 2021. Of those patients, 72 had a positive (pos) urine drug screen (UDS) for cocaine. There were 28 patients in the acute use group (UDS pos <14 d from procedure), 44 in the remote use group (UDS pos >14 d and <12 months from procedure), and 58 in the non-use group defined as no positive UDS result within 12 months from procedure. Group comparisons were performed using 1-way analysis of variance and chi-square or Fisher’s exact tests. Uni-variable and multivariable binary logistic regression analyses were performed to estimate odds ratios for peri-procedural cardiopulmonary adverse events (hypotension, tachycardia, oxygen desaturation, and cardiac arrest). Results: Overall, 30 (23.1%) peri-procedural adverse events were recorded with statistical significance in distribution between the 3 groups [14 (50%) acute vs 9 (20.5%) remote vs 7 (12.1%) non-use, P < 0.001]. In total, 2 (7.1%) cardiac arrest events were recorded in the acute use group (P < 0.046). Compared to cocaine non-users, controlling for age and sex, odds of peri-procedural cardiopulmonary adverse events were significantly greater in acute cocaine users (aOR: 5.67, 95% CI: 1.90-18.2, P = 0.002) and non-significantly increased in remote cocaine users (aOR: 1.33, 95% CI: 0.41-4.39, P = 0.64). Conclusion: Our study found a statistically significant increase in peri-procedural cardiopulmonary adverse events in the acute cocaine use group compared to the remote and non-user groups. These results suggest that performing EGD and/or colonoscopy in patients with acute cocaine use is unsafe from a cardiopulmonary standpoint.