From the Research
Transesophageal echocardiogram (TEE) can be performed in patients with grade 1 esophageal varices, with a low incidence of gastrointestinal bleeding, as evidenced by a recent systematic review and meta-analysis 1. The incidence of post-TEE bleeding in patients with varices was found to be 0.84% (95% CI, 0.34% to 1.56%) 1. When considering TEE in patients with grade 1 esophageal varices, it is essential to weigh the benefits against the potential risks of variceal bleeding. Some key points to consider include:
- The use of prophylactic measures such as non-selective beta-blockers to reduce portal pressure 2, 3
- The importance of performing the procedure with minimal pressure and avoiding unnecessary manipulation 2, 3
- The need for an experienced operator with emergency equipment readily available 2, 3
- The consideration of alternative imaging modalities like transthoracic echocardiography, cardiac CT, or cardiac MRI if they can provide the necessary diagnostic information 2, 3 It is also crucial to note that the main concern with TEE in these patients is mechanical trauma to the varices from the probe, which could trigger bleeding, a potentially serious complication given that esophageal varices result from portal hypertension and have fragile walls 2, 3. Overall, the decision to perform TEE in patients with grade 1 esophageal varices should be made on a case-by-case basis, taking into account the individual patient's risk factors and the potential benefits of the procedure 1, 4.