Endoscopy 2002; 34(10): 797-800
DOI: 10.1055/s-2002-34270
Original Article

© Georg Thieme Verlag Stuttgart · New York

Endoscopic Retrograde Cholangiopancreatography Causes Reduced Myocardial Blood Flow

M.  Christensen 1 , H.  W.  Hendel 2 , V.  Rasmussen 3 , L.  Højgaard 2 , S.  Schulze 1 , J.  Rosenberg 1
  • 1Department of Surgical Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark
  • 2Department of Nuclear Medicine and Clinical Physiology, Hvidovre University Hospital, Hvidovre, Denmark
  • 3Holter Laboratory, Department of Cardiology, Hvidovre University Hospital, Hvidovre, Denmark
Further Information

Publication History

Submitted: 30 November 2001

Accepted after Revision: 21 May 2002

Publication Date:
23 September 2002 (online)

Background and Study Aims: Previous studies have shown that up to 50 % of healthy patients may develop ST-segment changes during upper gastrointestinal endoscopy. The aim of the study was to evaluate myocardial blood flow in patients during endoscopic retrograde cholangiopancreatography (ERCP).
Patients and Methods: 11 patients scheduled for ERCP were monitored with a Holter tape recorder and underwent myocardial perfusion scintigraphies, to evaluate myocardial perfusion at rest and during ERCP.

Results: Ten patients completed the study. Eight patients had no sign of myocardial ischemia with either of the two methods, while two patients developed signs of ischemia during ERCP with both the Holter tape recording and on myocardial scintigraphy (P = 0.02).
Conclusions: Patients undergoing ERCP may develop true myocardial ischemia with reduced myocardial blood flow. Although this is a small-scale study, these findings strongly support the use of alternative methods for diagnostic evaluation of the pancreatic duct and biliary tree.

References

  • 1 Holm C, Rosenberg J. Pulse oximetry and supplemental oxygen during gastrointestinal endoscopy.  Endoscopy. 1996;  28 703-711
  • 2 Rosenberg J, Jørgensen L N, Rasmussen V. et al . Hypoxemia and myocardial ischemia during and after endoscopic retrograde cholangiopancreatography: calI for further studies.  Scand J Gastroenterol. 1992;  27 717-720
  • 3 Rosenberg J, Overgaard H, Andersen M. et al . Double blind randomized controlled trial of effect of metoprolol on myocardial ischemia during endoscopic retrograde cholangiopancreatography.  BMJ. 1996;  313 258-261
  • 4 Christensen M, Rasmussen V, Schulze S. et al . Vagal withdrawal during endoscopic retrograde cholangiopancreatography.  Scand J Gastroenterol. 2000;  35 96-101
  • 5 Hayashi T, Nomura M, Honda H. et al . Evaluation of autonomic nervous function during upper gastrointestinal endoscopy using heart rate variability.  J Gastroenterol. 2000;  35 815-823
  • 6 Hart R, Classen M. Complications of diagnostic gastrointestinal endoscopy.  Endoscopy. 1990;  22 229-233
  • 7 Freeman M L, Nelson D B, Sherman S. et al . Complications of endoscopic biliary sphincterotomy.  N Engl J Med. 1996;  335 909-918
  • 8 Oei-Lim V LB, Kalkman C J, Bartelsman J WFM. et al . Cardiovascular responses, arterial oxygen saturation and plasma catecholamine concentration during upper gastrointestinal endoscopy using conscious sedation with midazolam or propofol.  Eur J Anaesth. 1998;  15 535-543
  • 9 Leppo J A, Johnson L L. A review of cardiac imaging with sestamibi and teborixime.  J Nucl Med. 1991;  32 2012-2022
  • 10 Quine M A, Bell G D, McCloy R F. et al . Prospective audit of upper gastrointestinal endoscopy in two regions in England: safety, staffing, and sedation methods.  Gut. 1995;  36 462-467
  • 11 Silvis S E, Nebel O, Rogers G. et al . Endoscopic complications.  JAMA. 1976;  235 928-930
  • 12 Fujita R, Kumura F. Arrhythmias and ischemic changes of the heart induced by gastric endoscopic procedures.  Am J Gastroenterol. 1974;  64 44-48
  • 13 Harloff M, Weber J, Kohler B. et al . Bedeutung der kardiozirkulatorischen und pulmonalen Überwachung bei endoskopisch-retrograden Cholangiopankreatographien (ERCP).  Z Gastroenterol. 1991;  29 387-391
  • 14 Woods S DS, Chung S CS, Leung J WC. et al . Hypoxia and tachycardia during endoscopic retrograde cholangiopancreatography: detection by pulse oximetry.  Gastrointest Endosc. 1989;  35 523-525
  • 15 Rozen P, Fireman Z, Gilat T. Arterial-Oxygen tension changes in elderly patients undergoing upper gastrointestinal endoscopy. II. Influence of the narcotic premedication and endoscope diameter.  Scand J Gastroenterol. 1981;  16 299-303
  • 16 Mulcahy H E, Riches A, Kiely M. et al . A prospective controlled trial of an ultrathin versus a conventional endoscope in unsedated upper gastrointestinal endoscopy.  Endoscopy. 2001;  33 311-316
  • 17 Jurell K R, O'Connor K W, Slack J. et al . Effect of supplemental oxygen on cardiopulmonary changes during gastrointestinal endoscopy.  Gastrointest Endosc. 1994;  40 665-670
  • 18 Bowling T E, Hadjiminas C L, Polson R J. et al . Effects of supplemental oxygen on cardiac rhythm during upper gastrointestinal endoscopy: a randomised controlled double blind trial.  Gut. 1993;  34 1492-1497
  • 19 Rosenberg J, Stausholm K, Andersen I B. et al . No effect of oxygen therapy on myocardial ischemia during gastroscopy.  Scand J Gastroenterol. 1996;  31 200-205
  • 20 Haines D J, Bibbey D, Green J RB. Does nasal oxygen reduce the cardiorespiratory problems experienced by elderly patients undergoing endoscopic retrograde cholangiopancreatography?.  Gut. 1992;  33 973-975
  • 21 Vacca G, Mary D ASG, Vono P. The effect of distension of the stomach on coronary blood flow in anaesthetized pigs.  Pflügers Arch. 1994;  428 127-133
  • 22 Gilbert N C, LeRoy G V, Fenn G K. The effect of distension of abdominal viscera on the blood flow in the circumflex branch of the left coronary artery of the dog.  Am Heart J. 1940;  20 519-524
  • 23 Tønnesen H, Puggaard L, Braagaard H. et al . Stress response to endoscopy.  Scand J Gastroenterol. 1999;  34 629-631
  • 24 Campo R, Montserrat A, Brullet E. Transnasal gastroscopy compared to conventional gastroscopy: a randomised study of feasibility, safety, and tolerance.  Endoscopy. 1998;  30 448-452

M. Christensen

Department of Surgical Gastroenterology · Hvidovre University Hospital

Kettegaard Allé 30 · 2650 Hvidovre · Denmark

Fax: + 45-3632-3760

Email: merete.Christensen@dadlnet.dk