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. 2024 Feb;17(1):1-9.
doi: 10.14740/gr1661. Epub 2024 Feb 28.

Pre- and Post-Implant Endoscopy in Left Ventricular Assist Device Recipients: A Single-Center Experience

Wael T Mohamed  1 , Vinay Jahagirdar  1 , Fouad Jaber  1 , Mohamed K Ahmed  2 , Hassan M Ghoz  2 , Brett W Sperry  3 , Wendell K Clarkston  2   4
Affiliations

Pre- and Post-Implant Endoscopy in Left Ventricular Assist Device Recipients: A Single-Center Experience

Wael T Mohamed et al. Gastroenterology Res. 2024 Feb.

Abstract

Background: Gastrointestinal bleeding (GIB) is common in left ventricular assist devices (LVADs) patients, but the optimal screening approach before LVAD implantation is still unclear. The aim of the study was to describe our experience with pre- and post-LVAD implantation endoscopic screening and subsequent GI bleeding in this cohort.

Methods: A retrospective review was conducted among all patients who underwent LVAD implantation at Saint Luke's Hospital, between 2010 and 2020. The data were reviewed to determine the yield and safety of endoscopic procedures performed within 1 month before LVAD placement and the incidence of GIB within 1 year after implantation.

Results: A total of 167 LVAD patients met the inclusion criteria, and 23 underwent pre-implantation endoscopic evaluation. Angiodysplasia had a significantly higher odds ratio (OR) of 9.41 (95% confidence interval (CI): 2.01 - 44.09) in post-LVAD endoscopy, while there was no significant difference in bleeding from other sources such as peptic ulcer disease or diverticular bleeding. There was no difference in the incidence of GIB in patients who underwent endoscopic evaluation pre-LVAD compared to post-LVAD GIB (32.6% vs. 39.1%, P = 0.64). Endoscopy was well-tolerated in this cohort, and argon plasma coagulation was the most commonly used intervention to achieve hemostasis.

Conclusions: According to our results, we recommend against routine pre-LVAD endoscopic screening. Instead, we suggest an individualized approach, where decisions are made on a case-by-case basis.

Keywords: Angiodysplasias; Endoscopy; Gastrointestinal bleeding; Left ventricular assist device.

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Conflict of interest statement

All other authors have no conflict of interest to disclose.

Figures

Figure 1
Figure 1
Comparison of the incidence of gastrointestinal bleeding (GIB) between patients who underwent pre-left ventricular assist device (LVAD) endoscopic evaluation and those who did not.
Figure 2
Figure 2
Incidence of GIB in those who did undergo pre-LVAD endoscopic evaluation compared to those who did not. GIB: gastrointestinal bleeding; LVAD: left ventricular assist device.
Figure 3
Figure 3
Diagnostic yield of endoscopy in identifying source of bleeding within 1 year post-LVAD placement. LVAD: left ventricular assist device.
Figure 4
Figure 4
Therapeutic yield of endoscopy within 1year post-LVAD placement. LVAD: left ventricular assist device; APC: argon plasma coagulation.
See this image and copyright information in PMC

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