Changes in cardiopulmonary parameters during upper gastrointestinal endoscopy in patients with heart disease: Towards safer endoscopy

Background and Study Aims: Gastrointestinal endoscopy is an invasive examin ation. The aims of this study were to elucidate the effects and risks of up per gastrointestinal endoscopy with regard to cardiopulmonary functions in patients with heart disease, and to establish safety guidelines for use dur ing endoscopy in this particular group of patients. Patients and Methods: The patients involved were 53 inpatients in whom uppe r gastrointestinal endoscopy was carried out before cardiac surgery. Their cardiac functions had been evaluated previously. Electrocardiography with t wo leads (II, V5) was used, and blood pressure and peripheral oxygen satura tion (SpO(2)) were monitored throughout the procedure. The relationship bet ween the changes in cardiopulmonary parameters during endoscopy and the car diac functions was analyzed. Results: Heart rate increased immediately after insertion of the endoscope (P<0.01), There was a significantly higher incidence of ventricular and sup raventricular extrasystoles during observation of the second portion of the duodenum (P<0.05). A lower cardiac index (P<0.05) and a higher New York He art Association (NYHA) functional classification (P<0.05) were found in pat ients with oxygen desaturation than in patients without it. Two patients wi th severe coronary artery lesions showed marked ST-T depression, and these ischemic changes were thought to be due to increase in cardiac work during endoscopy. Conclsions: Upper gastrointestinal endoscopy has many adverse effects on ca rdiopulmonary functions in patients with heart disease. In our study, the c linical value of very close monitoring and administration of oxygen for pat ients with heart disease was confirmed by objective data.