GASTROINTESTINAL ENDOSCOPY IN HIGH-RISK PATIENTS

In America more than 100,000 high-risk patients/year have conditions n ormally evaluated by gastrointestinal endoscopy. This review analyzes the safety and efficacy of gastrointestinal endoscopy in high-risk pat ients. Endoscopy during pregnancy raises the unique issue of fetal saf ety. The safety of esophagogastroduodenoscopy (EGD) during pregnancy h as been examined in a case-controlled study of 83 patients, a mailed s urvey of 73 patients, and case reports. The safety of sigmoidoscopy du ring pregnancy has been examined in a case-controlled study of 45 pati ents, a mailed survey of 26 patients, and case reports. These studies that EGD and sigmoidoscopy are not contraindicated during pregnancy. F or example, EGD should be performed for significant upper gastrointest inal bleeding. The safety of colonoscopy during pregnancy is inadequat ely analyzed. In a study of 34 EGDs performed within 3 weeks of myocar dial infarction, no endoscopic complications occurred in 26 clinically stable patients with uncomplicated myocardial infarction. However, 3 major endoscopic complications occurred in 8 clinically unstable patie nts. In a study of 9 sigmoidoscopies within 3 weeks of myocardinal inf arction, no sigmoidoscopic complications occurred in 7 clinically stab le patients. Several studies have shown that EGD, sigmoidoscopy, or co lonoscopy is safe in patients with advanced HIV infection. AIDS patien ts should generally be endoscoped with the same aggressiveness as othe r patients. However, endoscopy may be unwise in any terminal patients. No complication occurred in 60 patients undergoing EGD within 3 weeks of esophageal, gastric, or duodenal surgery. One minor complication o ccurred in 36 patients undergoing sigmoidoscopy within 3 weeks of colo nic surgery. These results suggest that EGD or sigmoidoscopy is not co ntraindicated within 3 weeks of gastrointestinal surgery. No complicat ions occurred in 53 chronic obstructive pulmonary disease undergoing E GD. EGD appears to be safe in chronic obstructive pulmonary disease pa tients without severe hypoxemia or acute bronchospasm. Emergency EGD c an be performed in patients with severe hypoxemia after endotracheal i ntubation.