Safety of push enteroscopy after recent myocardial infarction

Although the safety and efficacy of esophagogastroduodenoscopy (EGD) after myocardial infarction (MI) are fairly well characterized, the safety of enteroscopy after recent MI is unstudied and unknown. Enteroscopy could potentially be particularly valuable to evaluate recurrent obscure gastrointestinal (GI) bleeding after MI because ongoing GI bleeding could induce recurrent myocardial ischemia. The safety of push enteroscopy is analyzed in a study of 4 cases among 8900 patients with acute MIs during an 8-year period at a tertiary care medical center. Four patients underwent enteroscopy at 1, 4, 28, and 45 days after MI, of whom three were prospectively monitored for enteroscopic complications. The patients were 82, 63, 72, and 76 years old. Three were male. The mean serum creatinine kinase level was 601 +/- 162 U/L, with an MB fraction of 15.9 +/- 13.2%. All MIs were subendocardial. Enteroscopy indications included recurrent fecal occult blood and anemia requiring multiple packed erythrocyte transfusions with no significant lesions identified by EGD and colonoscopy in two patients, maroon stools with no lesions identified by colonoscopy and only anastomotic erosions identified by EGD in one patient status post-Billroth I gastrectomy, and dark red blood per rectum in one patient with prior aortic graft revision for an aortoenteric fistula after failure to visualize the distal duodenum by EGD. The patients received a mean of 4.0 +/- 1.3 U of packed erythrocytes before enteroscopy. At enteroscopy the mean hematocrit was 32.7 +/- 1.6. The patients received a mean of 18.8 +/- 12.5 mg of meperidine and 2.6 +/- 2.2 mg of midazolam during enteroscopy. Enteroscopy was uniformly uncomplicated. Vital signs and arterial oxygen saturation remained stable during and following enteroscopy. Enteroscopy revealed no new lesions in two patients and distal duodenitis in one patient and ruled out an aortoenteric fistual in one patient at high risk for this lesion. These four cases suggest that enteroscopy is not absolutely contraindicated and might be considered after recent MI for strong indications in relatively clinically stable patients.