Gastroscopy and Colonoscopy Appear to Be Safe in High-Risk Patients Following a Recent Vascular Event

Aims A higher pre-endoscopy American Society of Anesthesiology (ASA) classification correlates with negative patient outcomes. Thus, for ASA class≥4 patients, anesthesia support is required. This includes patients with a recent (< 3 months) transient ischemic attack (TIA), cerebrovascular accident (CVA), or myocardial infarction (MI). We investigated the safety of gastroscopy and colonoscopy in high-risk patients following a recent vascular event [1] [2] [3] [4] [5] [6] [7] [8] [9].

Methods We performed a retrospective matched case-control study using the Clalit Healthcare Services database. Data was collected on patients who underwent gastroscopy or colonoscopy with or without polypectomy between 2010-2022. “High risk cases” were a priori defined as ASA class 4 patients undergoing endoscopy within 3 months of a vascular event. “Low risk controls” were defined as ASA class 3 patients undergoing endoscopy 3-6 months after a vascular event. We evaluated the primary outcome of mortality at 24 hours, 48 hours and at 7 days post endoscopy.

Results We identified a total of 2,883 patients who met our inclusion criteria with 1:1 matching: 1,434 high risk cases and 1,449 low risk controls. Overall, for all vascular events (TIA, CVA, MI) no statistically significant difference was observed in mortality at 24-hours (0.2% vs. 0%, p=0.60 for both CVA and acute MI, no deaths following TIA) nor at 48-hours (0.4% vs. 0.2% p=1.0 after MI, 1.3% vs. 0.2% p=0.09 after CVA, 0.3% vs. 0% p=0.9 after TIA) post- procedure. The mortality rate was significantly higher for the high-risk group compared with the control group after a CVA, both at 7 days post-procedure (3.2% vs. 0.4%, p=0.001) and at 30 days post-procedure (8.3% vs. 2.4%, p<0.001), with no mortality difference observed at 7 days and at 30 days post-procedure, between cases and controls after acute MI (0.9% vs. 0.4%, p=0.47 at 7 days, 3% vs. 1.3%, p=0.17 at 30 days) or TIA (0.3% vs. 0%, p=0.9 at 7 days, 0.6% vs. 0.3%, p=0.77 at 30 days). Only 3 post procedure gastrointestinal bleeding (GIB) events were documented, with no difference observed between cases and controls for all three types of vascular events.

Conclusions For “high risk” patients defined per ASA Classification and having had a recent vascular event, gastroscopy and colonoscopy do not appear to pose a significantly increased risk for post-endoscopy mortality after acute MI or TIA.

Conflicts of Interest

IM Gralnek is a consultant to Boston Scientific, Medtronic, Motus GI, Olympus, ERBE, and has received research funding from AstraZeneca and CheckCap.

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Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025