Illicit Drug Use and Endoscopy: When Do We Say No?

Area of Science:

• Gastroenterology
• Anesthesiology
• Addiction Medicine

Background:

• Illicit drug use (IDU) presents challenges for elective ambulatory surgery, particularly endoscopy.
• Systemic effects of illicit drugs raise concerns about increased cardiopulmonary complications during procedures.
• Current guidelines for managing IDU patients undergoing outpatient endoscopy are lacking.

Purpose of the Study:

• To review literature for optimal management strategies of outpatient elective endoscopic procedures in patients with IDU.
• To offer clinical guidance for endoscopists encountering IDU in practice.

Main Methods:

• Systematic literature review conducted across PubMed, CINAHL, Embase, and Google Scholar.
• Focused on studies reporting outcomes of elective procedures in patients using illicit drugs.

Main Results:

• Cannabis users showed no significant periprocedural complications or mortality differences compared to non-users.
• Endoscopy outcomes in patients with remote cocaine use were comparable to those with recent use.

Conclusions:

• Routine cancellation of endoscopy for IDU without considering drug type, dosage, or chronicity can delay care and increase morbidity.
• Developing guidelines for evaluating IDU patients for acute intoxication is recommended.
• Proceeding with endoscopy in non-intoxicated patients with a history of IDU may be safe and beneficial.