Published online Oct 16, 2021. doi: 10.4253/wjge.v13.i10.510
Peer-review started: May 26, 2021
First decision: June 12, 2021
Revised: July 1, 2021
Accepted: August 24, 2021
Article in press: August 24, 2021
Published online: October 16, 2021
Cocaine is a synthetic alkaloid initially viewed as a useful local anesthetic, but which eventually fell out of favor given its high addiction potential. Its predominantly sympathetic effects raise concern for cardiovascular, respiratory, and central nervous system complications in patients undergoing procedures. Peri-procedural cocaine use, often detected via a positive urine toxicology test, has been mostly addressed in the surgical and obstetrical literature. However, there are no clear guidelines on how to effectively risk stratify patients found to be positive for cocaine in the pre-operative setting, often leading to costly procedure cancellations. Within the field of gastroenterology, there is no current data available regarding safety of performing esophagogastroduodenoscopy (EGD) in patients with recent cocaine use.
To compare the prevalence of EGD related complications between active (≤ 5 d) and remote (> 5 d) users of cocaine.
In total, 48 patients who underwent an EGD at John H. Stroger, Jr. Hospital of Cook County from October 2016 to October 2018 were found to have a positive urine drug screen for cocaine (23 recent and 25 remote). Descriptive statistics were compiled for patient demographics. Statistical tests used to analyze patient characteristics, procedure details, and preprocedural adverse events included t-test, chi-square, Wilcoxon rank sum, and Fisher exact test.
Overall, 20 periprocedural events were recorded with no statistically significant difference in distribution between the two groups (12 active vs 8 remote, P = 0.09). Pre- and post-procedure hemodynamics demonstrated only a statistically, but not clinically significant drop in systolic blood pressure and increase in heart rate in the active user group, as well as drop in diastolic blood pressure and oxygen saturation in the remote group (P < 0.05). There were no significant differences in overall hemodynamics between both groups.
Our study found no significant difference in the rate of periprocedural adverse events during EGD in patients with recent vs remote use of cocaine. Interestingly, there were significantly more patients (30%) with active use of cocaine that required general anesthesia as compared to remote users (0%).
Core Tip: There is no data available regarding safety of performing an esophagogastroduodenoscopy in patients with evidence of recent cocaine use. This study compared the prevalence of procedure complications between active and remote cocaine users and found no statistically significant difference between the two groups. Pre- and post-procedure hemodynamics demonstrated only statistically, but not clinically significant changes in blood pressure, heart rate, and oxygenation. Results suggest relative safety in performing this procedure on active cocaine users. Patients in the active group required more general anesthesia; however, given nature of study, the reasoning behind this sedation choice was difficult to determine.