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Incidence and Associated Patient Characteristics of Gastrointestinal Bleeding Following Transesophageal

Yuki Okazawa¹, Satomi Yoshida², Kentaro Miyake³

¹Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan; Department of Anesthesiology and Critical Care, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.

Journal of Cardiothoracic and Vascular Anesthesia

|January 30, 2026

Insights

Upper gastrointestinal bleeding (UGIB) incidence after transesophageal echocardiography (TEE) is similar in transcatheter structural heart interventions (SHIs) and cardiac surgery. Close monitoring for UGIB is crucial due to increased mortality in both patient groups.

Area of Science:

Cardiology
Gastroenterology
Epidemiology

Background:

Transesophageal echocardiography (TEE) is integral to transcatheter structural heart interventions (SHIs) and cardiac surgery.
Upper gastrointestinal bleeding (UGIB) is a potential complication following invasive cardiac procedures.

Purpose of the Study:

To determine and compare the incidence and characteristics of UGIB within 3 and 7 days post-TEE.
To analyze risk factors and mortality associated with UGIB in SHI and cardiac surgery patients.

Main Methods:

A descriptive epidemiological study utilized the JMDC administrative database (April 2014 - December 2023).
Included were patients aged ≥18 undergoing SHI (n=5,758) or cardiac surgery (n=32,035) with same-day TEE.
Exclusion criteria addressed prior UGIB, specific procedures, and data completeness.

Main Results:

UGIB incidence within 3 days post-TEE was comparable: 0.17% for SHI and 0.18% for cardiac surgery.
Nearly half of UGIB cases (48% SHI, 57% surgery) occurred within the first 3 days.
In-hospital mortality was significantly higher with early UGIB in both SHI (20.0%) and cardiac surgery (8.5%) cohorts.

Conclusions:

UGIB incidence is similar between SHI and cardiac surgery cohorts following TEE.
A substantial proportion of UGIB cases manifest early, highlighting the need for vigilant post-procedure monitoring.
Early UGIB is associated with increased mortality, emphasizing the importance of prompt diagnosis and management.

Read full analysis

Abstract

Objectives:

To describe the incidence and baseline characteristics of upper gastrointestinal bleeding (UGIB) within 3 and 7 days of transesophageal echocardiography (TEE) in transcatheter structural heart interventions (SHIs) and cardiac surgery using uniform diagnostic criteria.

Design:

A descriptive epidemiological study using an administrative database.

Setting:

JMDC hospital database between April 2014 and December 2023.

Participants:

Patients aged ≥18 years who underwent SHI (n = 5,758) or cardiac surgery (n = 32,035) with same-day TEE. The exclusion criteria were multiple SHI procedures; combined SHI with cardiovascular surgery; UGIB, mechanical circulatory support, or prior TEE within 7 days preoperatively; and missing anesthesia duration data.

Interventions:

None.

Measurements And Main Results:

The incidence proportion of UGIB within 3 days postoperatively was comparable between SHI and cardiac surgery cohorts (0.17%; 95% CI, 0.09%-0.32% v 0.18%; 95% CI, 0.14%-0.24%). Among patients with UGIB by day 7, 48% (10/21) in SHI and 57% (59/104) in cardiac surgery presented within 3 days. In-hospital mortality was higher with UGIB within 3 days than without UGIB in both the SHI (20.0% v 1.3%) and cardiac surgery (8.5% v 4.5%) cohorts. Prolonged duration of anesthesia was associated with increased UGIB in both groups. Additional factors associated with UGIB differed by procedure type.

Conclusions:

Using identical diagnostic criteria, this study demonstrates similar incidence proportions of UGIB in the SHI and cardiac surgery cohorts, with approximately half of cases presenting within 3 days. The increased mortality observed in both groups underscores the need for careful monitoring for UGIB.

Keywords:

cardiac surgery postoperative complication transcatheter structural heart intervention transesophageal echocardiography upper gastrointestinal bleeding

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