Alexander Nguyen, MD1, Parth M. Desai, DO2, John Yap, MD2, Jie Yu, MD2, Vikram Kotwal, MD2, Bashar M. Attar, MD, PhD1
1Cook County Health and Hospital Systems, Chicago, IL; 2John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
Introduction: The timing of when to perform endoscopy in patients with a positive cocaine urine
drug screen (UDS+C) varies across institutions and is based on expert opinions and personal experience.
There are no clear published guidelines or reported studies in the English literature examining the safety
of endoscopy in active users of cocaine. This study aimed to describe the incidence of adverse events of
esophagogastroduodenoscopy (EGD) in patients with active cocaine use in a single inner-city tertiary
hospital in Chicago.
Methods: We examined consecutive records of patients who underwent an EGD at the John H. Stroger,
Jr. Hospital of Cook County from October 2016 to October 2018 and identified those who had a UDS+C
within 4 days. We examined the demographics and outcomes of these patients including pre- and post-
procedure hemodynamics. Paired T-tests were used to analyze the periprocedural hemodynamics.
Results: A total of 2122 patients were identified during the study period of which 129 patients had a
positive urine drug screen and 50 had a UDS+C. From these patients, we identified 20 who had a UDS+C
within 4 days of an EGD. These active users were predominately male (n=16) and African-American
(n=14). The majority underwent urgent procedures (n=16) in an inpatient setting (n=19). The average
time since a UDS+C was 2.3 days (SD±1.26). 8 patients were ASA class II and 12 were ASA class III. 14
patients underwent monitored anesthesia care (MAC) sedation and 6 underwent general anesthesia. 12
patients had abnormal electrocardiograms. The most frequent comorbidity was concurrent drug or
alcohol abuse (n=14) followed by hypertension (n=7). There were no adverse endoscopic or anesthesia
events, but 3 patients had transient procedural events (1 with oxygen desaturation and 2 with
hypotension). Pre- and post-procedure hemodynamics were within normal ranges and blood pressure
showed a statistically but not clinically significant decrease from a mean of 136/79 mmHg to 129/77
Discussion: No major adverse events occurred in the active cocaine users undergoing EGD in our
retrospective single center study. The decrease in blood pressure in our study was statistically but not
clinically significant. Our study suggests that EGD with anesthesia support appears to be safe in patients
with active cocaine use. More studies with larger sample sizes are needed to confirm these findings and
further guide the safety and timing of endoscopy in cocaine users.
Citation: Alexander Nguyen, MD; Parth M. Desai, DO; John Yap, MD; Jie Yu, MD; Vikram Kotwal, MD; Bashar M. Attar, MD, PhD. P2192 - SAFETY OF ESOPHAGOGASTRODUODENOSCOPY IN PATIENTS WITH ACTIVE COCAINE USE: A PILOT STUDY. Program No. P2192. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.