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. 2021 Jul 7;27(25):3877-3887.
doi: 10.3748/wjg.v27.i25.3877.

Does endoscopic intervention prevent subsequent gastrointestinal bleeding in patients with left ventricular assist devices? A retrospective study

Sonali Palchaudhuri  1 , Ishita Dhawan  2 , Afshin Parsikia  2 , Edo Y Birati  3 , Joyce Wald  3 , Shazia Mehmood Siddique  2 , Laurel R Fisher  2
Affiliations

Does endoscopic intervention prevent subsequent gastrointestinal bleeding in patients with left ventricular assist devices? A retrospective study

Sonali Palchaudhuri et al. World J Gastroenterol. .

Abstract

Background: Patients with left ventricular assist devices (LVADs) are at increased risk for recurrent gastrointestinal bleeding (GIB) and repeat endoscopic procedures. We assessed the frequency of endoscopy for GIB in patients with LVADs and the impact of endoscopic intervention on preventing a subsequent GIB.

Aim: To evaluate for an association between endoscopic intervention and subsequent GIB. Secondary aims were to assess the frequency of GIB in our cohort, describe GIB presentations and sources identified, and determine risk factors for recurrent GIB.

Methods: We conducted a retrospective cohort study of all patients at a large academic institution who underwent LVAD implantation from January 2011 - December 2018 and assessed all hospital encounters for GIB through December 2019. We performed a descriptive analysis of the GIB burden and the outcome of endoscopic procedures performed. We performed multivariate logistic regression to evaluate the association between endoscopic intervention and subsequent GIB.

Results: In the cohort of 295 patients, 97 (32.9%) had at least one GIB hospital encounter. There were 238 hospital encounters, with 55.4% (132/238) within the first year of LVAD implantation. GIB resolved on its own by discharge in 69.8% (164/235) encounters. Recurrent GIB occurred in 55.5% (54/97) of patients, accounting for 59.2% (141/238) of all encounters. Of the 85.7% (204/238) of encounters that included at least one endoscopic evaluation, an endoscopic intervention was performed in 34.8% (71/204). The adjusted odds ratio for subsequent GIB if an endoscopic intervention was performed during a GIB encounter was not significant (odds ratio 1.18, P = 0.58).

Conclusion: Patients implanted with LVADs whom experience recurrent GIB frequently undergo repeat admissions and endoscopic procedures. In this retrospective cohort study, adherence to endoscopic guidelines for performing endoscopic interventions did not significantly decrease the odds of subsequent GIB, thus suggesting the uniqueness of the LVAD population. A prospective study is needed to identify patients with LVAD at risk of recurrent GIB and determine more effective management strategies.

Keywords: Endoscopic intervention, Inpatient care; Gastrointestinal bleeding; Hospital readmissions; Left ventricular-assist device; Recurrent bleeding.

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Conflict of interest statement

Conflict-of-interest statement: Birati EY is recipient of research grants through the University from Impulse Dynamics and Medtronic. No relevant conflicts of interest to this manuscript; Fisher L site principle investigator for a Medtronic trial regarding video capsule endoscopy, but not related to LVADs. No relevant conflicts of interest to this manuscript; No disclosures or COI for the other authors.

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