A Study of Cardio Pulmonary Changes during Upper Gastrointestinal Endoscopy

Authors: Sharan Badiger, Prema T. Akkasaligar, P. Amith Kumar

Abstract:

Upper gastrointestinal endoscopy is a commonly performed diagnostic and therapeutic procedure and has many adverse effects like cardiopulmonary complications, complications related to sedation, infectious complications, bleeding and perforation. So this study was undertaken to evaluate important variables like patient’s age, gender and stage of the procedure in relation to the cardiopulmonary changes during diagnostic upper gastrointestinal endoscopy by monitoring oxygen saturation, blood pressure, heart rate and electrocardiogram. This is a prospective longitudinal hospital based study involving a total of 140 consecutive patients, at Sri. B. M. Patil Medical College, Hospital and Research Centre. Cardiopulmonary changes during upper gastrointestinal endoscopy are more common in the age groups of 51-60 years, with equal frequency in both male and female. Oxygen saturation levels decreased by about 4% in both sexes during introduction of endoscopy. Mild to moderate hypoxia was found in 32% of the study group. Severe hypoxia was found in 5% of the patients, mostly in those patients who are above 50 years of age. Tachycardia was noted in 88% of the study group patients. Blood pressure increased to hypertension levels in 22 patients (15.7%) which returned to normal within few minutes after the procedure. S-T depression was noticed in 4% of patients and T wave inversion in 8% of patients during upper gastrointestinal endoscopy. All these changes disappeared after 10 minutes after the endoscopy. Cardiopulmonary changes are common during upper gastrointestinal endoscopy. Maximum changes in oxygen saturation, heart rate and blood pressure occurred immediately after the introduction of endoscope. The cardiopulmonary changes did not manifest into any identifiable clinical symptoms. The rate of recovery was faster in younger age groups and women.

Keywords: Blood Pressure, Cardio-Pulmonary, Heart Rate, Oxygen Saturation, Upper Gastrointestinal Endoscopy.

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1336901

References:

[1] Sharan Badiger. Upper Gastrointestinal Endoscopy - Cardio-Pulmonary changes and Complications. International Journal of Current Scientific Research. 2012; 2, no.2: pp.350- 357.
[2] Douglas O. Faigel, Irving M. Pike, Todd H. Baron, Amitabh Chak, Jonathan Cohen, Stephen E. Deal, Brenda Hoffman et al. Quality Indicators for Gastrointestinal Endoscopic Procedures: An Introduction. American Journal of Gastroenterology 2006; 101, pp. 866-872.
[3] Bell G.D. Monitoring and safety in endoscopy. Baillière's Clinical Gastroenterology. 1991; 5, no.1: pp.79-98.
[4] Laajam M. A., I. A. Al-Mofleh, F. Z. Al-Faleh, A. K. Al-Aska, K. Jessen, J. Hussain, and R. S. Al-Rashed. Upper gastrointestinal endoscopy in Saudi Arabia: analysis of 6386 procedures. The Quarterly Journal of Medicine. 1988; 66, no. 249: pp.21-25.
[5] Dhariwal A, Plevris J. N, Lo N.T.C, Finlayson N.D.C, Heading R.C, Hayes, P.C., Age, anemia, and obesity-associated oxygen desaturation during upper gastrointestinal endoscopy, Gastrointestinal Endoscopy. 1992; 38, no: pp. 684-688.
[6] Javid G, Khan B, Wani M. M, Shah A, Gulzar G. M. Role of pulse oximetry during non-sedated upper gastrointestinal endoscopic procedures. Indian journal of gastroenterology: official journal of the Indian Society of Gastroenterology. 1999; 18, no.1: pp.15-17.
[7] Sun Young Yi, Arterial oxygen desaturation during non sedated diagnostic upper GI endoscopy. Korean Journal of Gastrointestinal Endoscopy.1996; 16: pp.25-29.
[8] Rozario, Lorraine, Donna Sloper, and Michael J. Sheridan. Supplemental oxygen during moderate sedation and the occurrence of clinically significant desaturation during endoscopic procedures. Gastroenterology Nursing. 2008; 31, no. 4: pp.281-285.
[9] Osinaike B. B., A Akere, T. O. Olajumoke, E. O. Oyebamiji Cardiorespiratory changes during upper gastrointestinal Endoscopy. Gastrointestinal Endoscopy. 1992; 38, pp.684-9.
[10] Ross Ruth, Julia L. Newton. Heart rate and blood pressure changes during gastroscopy in healthy older subjects. Gerontology. 2004; 50, no. 3: pp.182-186.
[11] Saijyo Tetsuya, Masahiro Nomura, Yutaka Nakaya, Ken Saito, Yuki Kondo, Michiko Yukinaka, Ichiro Shimizu, and Susumu Ito. Assessment of autonomic nervous activity during gastrointestinal endoscopy: analysis of blood pressure variability by tonometry. Journal of Gastroenterology and Hepatology. 1998; 13, no. 8: pp.816-820.
[12] Bhalla A, Sood A, Sachdeva, A, Duseja, Gupta V. Cardiorespiratory compromise under conscious sedation during upper gastrointestinal endoscopy. J Coll Physicians Surg Pak.2006; 16, no. 9: pp.585-589.
[13] Yetkin G., S. Oba, M. Uludag, I. Paksoy, I. Akgün, and N. Eren. Effects of sedation during upper gastrointestinal endoscopy on endocrine response and cardiorespiratory function. Brazilian Journal of Medical and Biological Research. 2007; 40, no. 12: pp.1647-1652.
[14] Mistry F.P., P. Abraham, and S. J. Bhatia. Oxygen desaturation and tachycardia during upper gastrointestinal endoscopy are transient and benign. The Journal of the Association of Physicians of India.1992; Aug; 40, no. 8: pp.524-527
[15] Malhotra H. S., S. Rana, L. S. Pal, and D. J. Dasgupta. Electrocardiographic changes during upper gastrointestinal endoscopy in ambient hypoxia. The Journal of the Association of Physicians of India.1991; 39, no. 9: pp.692-693
[16] Ulgen M.S, Y. Ates, Zeki Soypacaci, and T. Keles. Effects of upper gastrointestinal endoscopy on the cardiovascular system of asymptomatic middle-aged and elderly patients without heart disease. Turkish Journal of Gastroenterology. 2001; 12, no. 3: pp.214-217
[17] Murray A.W., C. G. Morran, G. N. C. Kenny, P. Macfarlane, and J. R. Anderson. Examination of cardiorespiratory changes during upper gastrointestinal endoscopy. Anaesthesia. 1991; 46, no. 3: pp.181-184.
[18] Seinelä Lauri, Pekka Reinikainen, and Jari Ahvenainen. Effect of upper gastrointestinal endoscopy on cardiopulmonary changes in very old patients. Archives of Gerontology and Geriatrics. 2003; 37, no. 1: pp.25-32.
[19] Hayashi Toru, Masahiro Nomura, Hirohito Honda, Kazuhiro Tezuka, Ryusuke Torisu, Yoshikazu Takeuchi, Yutaka Nakaya, and Susumu Ito. Evaluation of autonomic nervous function during upper gastrointestinal endoscopy using heart rate variability. Journal of Gastroenterology. 2000; 35, no. 11: pp.815-823.
[20] Alcaín Guillermo, Pablo Guillén, Antonio Escolar, Miguel Moreno, and Leopoldo Martín. Predictive factors of oxygen desaturation during upper gastrointestinal endoscopy in non-sedated patients. Gastrointestinal Endoscopy. 1998; 48, no. 2: pp.143-147.
[21] Mathew P.K., Ona F.V., Damevski K., Wallace W.A. Arrhythmias during upper gastrointestinal endoscopy. Angiology. 1979 Dec; 30, no.12: pp.834-840.
[22] Patrick Waring J, Todd H Baron, William K Hirota, Jay L Goldstein, Brian C Jacobson, Jonathan A Leighton et al. Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointestinal Endoscopy.2003; 58, no.3: pp. 317-322.