Implanted electronic devices at endoscopy: advice in a gray area.

In the course of a busy open-access endoscopy calendar, it is not uncommon for a gastroenterologist to encounter a patient who has an implanted medical device. What to do? Should the presence of the device influence the performance of the scheduled procedure? Should any particular precautions be taken? Does awareness and acknowledgement of the device engender any additional liability? Once noted, are measures available to reduce the risk for the patient? Unfortunately, we have very few objective data to guide us through these practical, everyday concerns. In this issue of GIE, a newly updated Technology Review article provides a discussion of the broad issues that are raised by performance of endoscopy and electrosurgical therapies in patients with implanted electronic devices. This document has received significant input from members of the national Heart Rhythm Society (HRS) and has been adopted by boards of both the HRS and the ASGE. Although the Technology Review article provides formal advice to endoscopists, it is worth independently noting the relatively subjective basis for the recommendations and how one might easily adopt the most pertinent guidance. Implanted electronic devices are now used to treat a wide array of cardiac, neurologic, and sensory problems, among others. Several new devices are described each year, and many are used in only a small number of patients. Hence, for most device types, there is neither experience nor objective data regarding their interactions with electrosurgical current. For these devices, generic precautions include the following: (1) ascertaining general type and location of the device; (2) determining whether the device can be inactivated or turned off during endoscopy to protect both the device and the patient; (3) striving to avoid use of electrosurgical current in tissue, perhaps favoring injection or clip applications, particularly when the implanted electronic device cannot be inactivated; and (4) when electrosurgical current is required, using the most localized form (bipolar rather than monopolar if appropriate) in short bursts at lower energy, preferably at a distance from the implanted device. These precautions are likely adequate for most intermittently active implanted devices of a noncritical nature, particularly when they are located a