Badr Al-Bawardy1, Sarah D Schettle2, Emmanuel Gorospe1, Louis M Wong Kee Song1, Naveen L Pereira2, Jeffrey A Alexander1, David H Bruining1, Nayantara Coelho-Prabhu1, Jeff L Fidler3, William J Mauermann4, David W Barbara4, Ross Dierkhising5, Elizabeth Rajan1. 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.
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.
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.
Entities:
Keywords:
Small bowel bleeding; balloon-assisted enteroscopy; capsule endoscopy; left ventricular assist device
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