{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T09:52:34Z","timestamp":1789638754434,"version":"4.0.0"},"reference-count":48,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T00:00:00Z","timestamp":1648425600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007827","name":"American College of Gastroenterology","doi-asserted-by":"publisher","award":["Junior Faculty Development Award"],"award-info":[{"award-number":["Junior Faculty Development Award"]}],"id":[{"id":"10.13039\/100007827","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01 CA256977"],"award-info":[{"award-number":["R01 CA256977"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The presence of esophageal varices is considered a relative contraindication to transesophageal echocardiography (TEE) by cardiology professional societies, so gastroenterologists are often consulted to perform upper endoscopy prior to TEE in patients with cirrhosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To perform a systematic review to quantify the risk of bleeding complications in patients with cirrhosis following TEE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Two reviewers searched Ovid MEDLINE, MEDLINE In\u2010Process and EMBASE databases from January 1992 to May 2021 for studies reporting bleeding complications from TEE in patients with cirrhosis. We calculated the pooled incidence rate of bleeding events using the <jats:italic>metaprop<\/jats:italic> command with a random effect model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 21 studies comprising 4050 unique patients with cirrhosis; 9 studies (<jats:italic>n<\/jats:italic>\u00a0=\u00a03015) assessed the risk of intraoperative TEE during liver transplant (LT) and 12 studies (<jats:italic>n<\/jats:italic>\u00a0=\u00a01035) assessed bleeding risk in patients undergoing TEE for other indications. The pooled incidence of bleeding post\u2010TEE was 0.37% (95% CI 0.04\u20130.94%) across all studies. Bleeding complications were low among patients undergoing TEE during LT as well as those undergoing TEE for other diagnostic reasons (0.97% vs. 0.004%) and among studies with mean MELD &gt;18 compared to those with mean MELD &lt;18 (0.43% vs. 0.08%). Few studies had a comparator arm, and data on patient\u2010level factors impacting bleeding complications (including degree of liver dysfunction and coagulopathy) were limited across studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The risk of bleeding complications following TEE is low in patients with cirrhosis, suggesting TEE is safe and risk stratification with upper endoscopy may not be necessary.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.16860","type":"journal-article","created":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T09:49:35Z","timestamp":1648460975000},"page":"1088-1098","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Systematic review with meta\u2010analysis: incidence of variceal hemorrhage in patients with cirrhosis undergoing transesophageal echocardiography"],"prefix":"10.1111","volume":"55","author":[{"given":"Mobolaji","family":"Odewole","sequence":"first","affiliation":[{"name":"Division of Digestive and Liver Diseases UT Southwestern Medical Center  Dallas Texas USA"},{"name":"Columbia University Irving Medical Center  New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahana","family":"Sen","sequence":"additional","affiliation":[{"name":"Division of Digestive and Liver Diseases UT Southwestern Medical Center  Dallas Texas USA"},{"name":"Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ehiamen","family":"Okoruwa","sequence":"additional","affiliation":[{"name":"Department of Medicine UT Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8304-4479","authenticated-orcid":false,"given":"Sarah R.","family":"Lieber","sequence":"additional","affiliation":[{"name":"Division of Digestive and Liver Diseases UT Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas G.","family":"Cotter","sequence":"additional","affiliation":[{"name":"Division of Digestive and Liver Diseases UT Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anh D.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Baylor Scott &amp; White Health  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjmand","family":"Mufti","sequence":"additional","affiliation":[{"name":"Division of Digestive and Liver Diseases UT Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1172-3971","authenticated-orcid":false,"given":"Amit 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