Display options
Cite
Al-Bawardy B, Schettle SD, Gorospe E, et al. Small bowel bleeding in patients with left ventricular assist device: outcomes of conservative therapy versus balloon-assisted enteroscopy. Ann Gastroenterol. 2018;31(6):692-697doi: 10.20524/aog.2018.0316.
Al-Bawardy, B., Schettle, S. D., Gorospe, E., Kee Song, L. M. W., Pereira, N. L., Alexander, J. A., Bruining, D. H., Coelho-Prabhu, N., Fidler, J. L., Mauermann, W. J., Barbara, D. W., Dierkhising, R., & Rajan, E. (2018). Small bowel bleeding in patients with left ventricular assist device: outcomes of conservative therapy versus balloon-assisted enteroscopy. Annals of gastroenterology, 31(6), 692-697. https://doi.org/10.20524/aog.2018.0316
Al-Bawardy, Badr, et al. "Small bowel bleeding in patients with left ventricular assist device: outcomes of conservative therapy versus balloon-assisted enteroscopy." Annals of gastroenterology vol. 31,6 (2018): 692-697. doi: https://doi.org/10.20524/aog.2018.0316
Al-Bawardy B, Schettle SD, Gorospe E, Kee Song LMW, Pereira NL, Alexander JA, Bruining DH, Coelho-Prabhu N, Fidler JL, Mauermann WJ, Barbara DW, Dierkhising R, Rajan E. Small bowel bleeding in patients with left ventricular assist device: outcomes of conservative therapy versus balloon-assisted enteroscopy. Ann Gastroenterol. 2018 Nov-Dec;31(6):692-697. doi: 10.20524/aog.2018.0316. Epub 2018 Sep 26. PMID: 30386119; PMCID: PMC6191869.
Copy Download .nbib Format: NLM
Share it on

Ann Gastroenterol. 2018 Nov-Dec;31(6):692-697. doi: 10.20524/aog.2018.0316. Epub 2018 Sep 26.

Small bowel bleeding in patients with left ventricular assist device: outcomes of conservative therapy versus balloon-assisted enteroscopy.

Annals of gastroenterology

Badr Al-Bawardy, Sarah D Schettle, Emmanuel Gorospe, Louis M Wong Kee Song, Naveen L Pereira, Jeffrey A Alexander, David H Bruining, Nayantara Coelho-Prabhu, Jeff L Fidler, William J Mauermann, David W Barbara, Ross Dierkhising, Elizabeth Rajan

Affiliations

  1. Division of Gastroenterology and Hepatology (Badr Al-Bawardy, Emmanuel Gorospe, Louis M. Wong Kee Song, Jeffrey A. Alexander, David H. Bruining, Nayantara Coelho-Prabhu, Elizabeth Rajan).
  2. Department of Cardiology (Sarah D. Schettle, Naveen L. Pereira), Mayo Clinic, Rochester, Rochester, MN, USA.
  3. Department of Radiology (Jeff L. Fidler), Mayo Clinic, Rochester, Rochester, MN, USA.
  4. Department of Anesthesiology (William J. Mauermann, David W. Barbara), Mayo Clinic, Rochester, Rochester, MN, USA.
  5. Division of Biomedical Statistics and Informatics (Ross Dierkhising), Mayo Clinic, Rochester, Rochester, MN, USA.

PMID: 30386119 PMCID: PMC6191869 DOI: 10.20524/aog.2018.0316

Abstract

BACKGROUND: Small bowel bleeding (SBB) accounts for 30% of gastrointestinal bleeding (GIB) episodes in patients with a left ventricular assist device (LVAD). The aim of this study was to determine the outcomes of conservative therapy (CT) compared to balloon-assisted enteroscopy (BAE) in the management of SBB in LVAD patients.

METHODS: A retrospective review was performed of a prospectively maintained LVAD database from January 2003 to July 2015. LVAD patients with SBB were classified into a BAE group or a CT group according to whether they did or did not undergo BAE.

RESULTS: Forty-two patients (22 BAE, 20 CT) with mean age 66±9.3 years (79% male) were included. The yield of BAE was 64% without reported complications. Overt re-bleeding occurred in 40% of the BAE group compared to 22% of the CT group. The BAE group had a higher mean number of GIB hospitalizations per month compared to the CT group (0.07 vs. 0.03; incidence rate ratio [IRR] 2.72, 95% CI 1.06-6.98; P=0.04). There was no significant difference between the BAE and the CT groups in the number of packed red blood cell (pRBC) transfusions per month (0.42 vs. 0.18; IRR 2.31, 95% CI 0.88-6.04; P=0.09) or all-cause mortality (61% in the CT group and 42% in the BAE group; P=0.90).

CONCLUSION: BAE is safe in LVAD patients and has a moderate therapeutic yield. In our cohort of patients, BAE did not appear to improve re-bleeding rate, GIB-related hospitalizations, pRBC transfusions or mortality compared to CT. However, future prospective trials with larger sample sizes are needed to confirm these findings.

Keywords: Small bowel bleeding; balloon-assisted enteroscopy; capsule endoscopy; left ventricular assist device

Conflict of interest statement

Conflict of Interest: None

References

  1. Gastrointest Endosc. 2014 Sep;80(3):435-446.e1 - PubMed
  2. Endoscopy. 2010;42 Suppl 2:E194 - PubMed
  3. Circ Heart Fail. 2013 May;6(3):517-26 - PubMed
  4. J Am Coll Cardiol. 2009 Jun 9;53(23):2162-7 - PubMed
  5. J Thorac Cardiovasc Surg. 2009 Jan;137(1):208-15 - PubMed
  6. Am J Gastroenterol. 2012 Feb;107(2):240-6 - PubMed
  7. Ann Thorac Surg. 2010 Oct;90(4):1263-9; discussion 1269 - PubMed
  8. J Heart Lung Transplant. 2012 Jul;31(7):715-8 - PubMed
  9. Gastroenterology Res. 2015 Dec;8(6):309-312 - PubMed
  10. Clin Cardiol. 2013 Apr;36(4):190-200 - PubMed
  11. J Heart Lung Transplant. 2014 Jan;33(1):60-4 - PubMed
  12. Clin Gastroenterol Hepatol. 2014 Sep;12(9):1461-7 - PubMed
  13. ASAIO J. 2015 Nov-Dec;61(6):670-5 - PubMed
  14. Circ Heart Fail. 2011 Nov;4(6):779-84 - PubMed
  15. Endoscopy. 2011 Sep;43(9):759-65 - PubMed
  16. J Am Coll Cardiol. 2010 Oct 5;56(15):1207-13 - PubMed
  17. N Engl J Med. 2001 Nov 15;345(20):1435-43 - PubMed
  18. JACC Heart Fail. 2014 Apr;2(2):141-5 - PubMed
  19. Clin Gastroenterol Hepatol. 2012 Aug;10(8):910-6 - PubMed
  20. Clin Gastroenterol Hepatol. 2015 Jan;13(1):107-14.e1 - PubMed
  21. Eur J Cardiothorac Surg. 2008 Apr;33(4):679-84 - PubMed
  22. J Card Surg. 2010 May;25(3):352-6 - PubMed
  23. Endoscopy. 2014 Nov;46(11):986-91 - PubMed

Publication Types