• Kent H Rehfeldt, J Ross Renew, Arun Subramanian, Juan N Pulido, and William J Mauermann.
• Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN. Electronic address: rehfeldt.kent@mayo.edu.
• J. Cardiothorac. Vasc. Anesth. 2020 Jul 1; 34 (7): 1846-1852.

ObjectivesExpert guidelines consistently list esophageal stricture (ES) as a contraindication to the performance of transesophageal echocardiography (TEE), although anecdotally the authors are aware of patients with ES undergoing TEE without apparent complication. Therefore the authors sought to determine the outcomes of patients with ES who had undergone TEE at their institution.DesignSingle-center, retrospective review.SettingAcademic medical center (clinic and affiliated hospital).ParticipantsPatients with documented ES who also underwent TEE.InterventionsNone.Measurements And Main ResultsIn a 10-year period, 1,083 TEE reports were generated for 823 patients who had a diagnosis of ES. One case of esophageal perforation occurred (1/1,083 examination reports [0.09%]) in an 85-year-old male with gastroesophageal reflux disease-related ES who had undergone esophageal dilation the same day as the TEE. In 17.2% of the TEE reports reviewed, changes to the conduct of the examination occurred, such as use of a pediatric probe or avoidance of transgastric imaging. In 8% of reviewed examinations, procedural difficulty was recorded.ConclusionsPatients with nonmalignant ES commonly present for TEE (>100 per year, on average, at the authors' institution). Severe TEE-related esophageal injury rarely occurred in patients with ES. However, changes to the conduct of the TEE examination and procedural difficulty were not infrequent in this group. Clinicians contemplating TEE in patients with ES should prepare for the possibility of altered examination conduct and possible procedural difficulty.Copyright © 2019 Elsevier Inc. All rights reserved.

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