Complications of Transesophageal Echocardiography: A Review of Injuries, Risk Factors, and Management

Transesophageal echocardiography (TEE) use has become widespread in cardiac surgical operating rooms over the last 2 decades. Surgical and medical decision-making often are guided by the findings of the TEE examination, rendering TEE an invaluable tool both inside and outside the operating room. TEE has become ubiquitous in some parts because it is considered safe and relatively noninvasive. However, it is imperative for clinicians to understand that TEE can cause severe and possibly life-threatening complications, and the risks of TEE must be balanced against its benefits as a diagnostic tool. Upper gastrointestinal (UGI) injuries are the most commonly described complications of TEE; however, the relative infrequency of injuries and lack of uniform reporting make it difficult to definitively identify potential risk factors. Some large retrospective trials suggested that patient factors (age, body mass index, anatomic abnormalities), comorbid conditions (previous stroke), and procedural variables (procedure time, cardiopulmonary bypass time, etc.) are associated with TEE-related injuries. In this narrative review of complications from TEE, the authors focus on the incidence of UGI injuries, the spectrum of injuries associated with TEE, risk factors that may contribute to UGI injuries, as well as diagnosis and management options. Lastly, the discussion focuses on the prevention of injuries as TEE use continues to become more prevalent. (C) 2022 Elsevier Inc. All rights reserved.

Automated summary

Transesophageal echocardiography (TEE) has become a widely used diagnostic tool in cardiac surgical operating rooms, both for surgical and medical decision-making. While considered safe and noninvasive, it is important to weigh the risks and benefits of TEE. Upper gastrointestinal (UGI) injuries are the most common complications associated with TEE, with patient factors and procedural variables playing a role. This review discusses the incidence, spectrum, risk factors, diagnosis, and management of UGI injuries, as well as the importance of injury prevention as TEE use continues to increase.