This is the current release of the guideline.

Summary Recommendations for Cardiac Devices

By recognizing that the paucity of published clinical data favoring any given approach, that the availability of heart rhythm specialty support varies by geographic region and practice setting, and that the variation in practice currently exists in this area, the following general recommendations are made to minimize the risks to patients with implanted cardiac devices who are undergoing endoscopic procedures that require the use of electrocautery.

• In all patients with implanted cardiac devices:
  • Determine the type of cardiac device, indication for the device, the patient's underlying cardiac rhythm, and degree of pacemaker-dependence before endoscopy. Most patients carry wallet cards that identify the device make and model, with manufacturer contact numbers. Contacting the patient's cardiologist or heart rhythm specialist and/or the device manufacturer may be helpful, especially in concert with the evaluation by an on-site heart rhythm specialist or device nurse.
  • Use continuous electrocardiographic rhythm monitoring in addition to pulse oximetry during the procedure.
  • Have appropriate equipment for resuscitation, cardioversion, and defibrillation immediately available. This should include an external defibrillator with transcutaneous pacing capability.
  • Consider the use of endoscopic devices with limited or no electromagnetic field (EMF) (such as noncautery thermal probes or bipolar/multipolar probes).
  • Use the lowest effective power output and the briefest application of the electrocautery device possible.
  • Place grounding pads a good distance from the pulse generator and leads, such that the implanted device and leads are not between the cautery source and the grounding pad.
  • Avoid use of cautery near implanted devices (some investigators advise avoiding therapy within 15 centimeters).
• Most patients with cardiac pacemakers may undergo routine uses of electrocautery (e.g., polypectomy, hemostasis) with no alterations in management.
• For patients who are pacemaker dependent and in whom prolonged electrocautery is anticipated (e.g., treatment of gastric antral vascular ectasia or radiation proctitis) consider reprogramming the pacemaker to an asynchronous mode via application of a magnet over the pulse generator during the use of electrocautery.
• For patients with an implantable cardioverter-defibrillator (ICD) in whom the use of any electrocautery may be anticipated, consultation with a cardiologist or a heart-rhythm specialist is recommended. Deactivation of the ICD function by qualified personnel should be considered. Continuous rhythm monitoring should be used throughout the interval that the ICD is deactivated. If deactivated, the ICD should be reprogrammed as soon as possible after the procedure and before cessation of monitoring or dismissal.
• If the patient with an ICD is also pacemaker dependent and the ICD cannot be reprogrammed to an asynchronous mode and prolonged cautery application may be required, then strongly consider the use of bipolar cautery or a device with no EMF.

Summary Recommendations for Noncardiac Devices

The type of electronic device, the indication for the device, and whether normal physiology is critically dependent upon the device should be determined. Most patients carry wallet cards that identify the device make and model, with manufacturer contact numbers. Contacting the patient's device specialist and/or the manufacturer may be helpful in planning device management during and after the procedure.

• Consider the use of endoscopic devices with limited or no EMF (such as noncautery thermal probes or bipolar/multipolar probes).
• Use the lowest effective power output and the briefest application of the electrocautery device possible.
• Place grounding pads a good distance from the device's generator and leads, so that the implanted device and leads are not between the cautery source and the grounding pad.
• Avoid the use of cautery near implanted devices.
• For patients with deep brain stimulator (DBS) and gastric electrical stimulation (GES) devices, consult the primary device specialist before considering inactivation of the device output.
• For patients with spinal cord and most other peripheral neurologic stimulation devices, have the patient zero the voltage output and then turn off the device before use of electrocautery.

Conclusions

Implanted electronic devices are increasingly encountered during gastrointestinal (GI) endoscopy. Endoscopists must be aware of the risks for patient injury and device damage or malfunction and must take precautionary steps to minimize the risk for their patients. The published data are quite limited. Further studies should address the risk of adverse events related to electromagnetic interference during GI endoscopy.

None provided

The type of evidence supporting the recommendations is not specifically stated.

Not applicable: The guideline was not adapted from another source.

2007 Apr

American Society for Gastrointestinal Endoscopy - Medical Specialty Society

American Society for Gastrointestinal Endoscopy

Technology Assessment Committee

Committee Members: Bret T. Petersen, MD, Chair; Nadeem Hussain, MD; Joseph E. Marine, MD*; Richard G. Trohman, MD*; Steven Carpenter, MD; Ram Chuttani, MD; Joseph Croffie, MD; James DiSario, MD; Poonputt Chotiprasidhi, MD; Julia Liu, MD; Lehel Somogyi, MD

*Heart Rhythm Society representatives

Not stated

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI Institute on March 4, 2008.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.