Safety of transesophageal echocardiography in patients who are obese

Patients with obesity tend to have a higher incidence of hypertension, coronary artery disease, and sleep apnea, conditions that could potentially predispose to complications during transesophageal echocardiography (TEE). In addition, patients who are obese are more likely to have oxygen desaturation during upper gastrointestinal endoscopy. However, the safety of TEE in a large cohort of patients with obesity has not been reported. Thus, the safety of TEE in 341 patients who were obese (body mass index >/= 27.5 kg/m(2), mean 41.0 +/- 10.3) and in 323 control patients who were not obese was compared. Minor complications (ie, complications of a transient duration and requiring no or only simple intervention) occurred with equal frequency in the control and obese groups (16.5% vs 16.7%, P = not significant). Transient oxygen desaturation did not differ between the control versus obese group (2.5% vs 3.8%, P = not significant), but was more common (6.7%) in a subgroup (n = 150) of patients who were morbidly obese as compared with control patients (P <.05). Transient hypotension was observed in 3.5% of the obese group compared with 7.4% in the control group (P <.05). However, transient hypertension was noted in 10.6% of the patients who were obese compared with 6.5% in the control group (P =.072). A major complication occurred in 2 patients with obesity, one who required vasopressor medication for persistent hypotension and another needing pharmacologic rate control of atrial fibrillation. One patient in the control group had provoked supraventricular tachycardia and angina. No deaths occurred in either group. Subjective tolerance for the procedure was similar (P = not significant) in both groups with 84% of patients with obesity having good to excellent tolerance compared with 88% in that of the control group. Thus, TEE can be safely performed in patients who are obese.