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

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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)692-697
Number of pages6
JournalAnnals of Gastroenterology
Volume31
Issue number6
DOIs
StatePublished - Oct 20 2018

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Heart-Assist Devices
Hemorrhage
Erythrocyte Transfusion
Hospitalization
Conservative Treatment
Balloon Enteroscopy
Mortality
Incidence
Sample Size
Databases

Keywords

  • Balloon-assisted enteroscopy
  • Capsule endoscopy
  • Left ventricular assist device
  • Small bowel bleeding

ASJC Scopus subject areas

  • Gastroenterology

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Small bowel bleeding in patients with left ventricular assist device : Outcomes of conservative therapy versus balloon-assisted enteroscopy. / Al-Bawardy, Badr; Schettle, Sarah D.; Gorospe, Emmanuel; Song, Louis M.Wong Kee; Pereira, Naveen Luke; Alexander, Jeffrey A.; Bruining, David H; Coelho-Prabhu, Nayantara; Fidler, Jeff L.; Mauermann, William J.; Barbara, David W.; Dierkhising, Ross; Rajan, Elizabeth.

In: Annals of Gastroenterology, Vol. 31, No. 6, 20.10.2018, p. 692-697.

Research output: Contribution to journalArticle

Al-Bawardy, B, Schettle, SD, Gorospe, E, Song, LMWK, Pereira, NL, Alexander, JA, Bruining, DH, Coelho-Prabhu, N, Fidler, JL, Mauermann, WJ, Barbara, DW, 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, vol. 31, no. 6, pp. 692-697. https://doi.org/10.20524/aog.2018.0316
Al-Bawardy, Badr ; Schettle, Sarah D. ; Gorospe, Emmanuel ; Song, Louis M.Wong Kee ; Pereira, Naveen Luke ; Alexander, Jeffrey A. ; Bruining, David H ; Coelho-Prabhu, Nayantara ; Fidler, Jeff L. ; Mauermann, William J. ; Barbara, David W. ; Dierkhising, Ross ; Rajan, Elizabeth. / Small bowel bleeding in patients with left ventricular assist device : Outcomes of conservative therapy versus balloon-assisted enteroscopy. In: Annals of Gastroenterology. 2018 ; Vol. 31, No. 6. pp. 692-697.
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title = "Small bowel bleeding in patients with left ventricular assist device: Outcomes of conservative therapy versus balloon-assisted enteroscopy",
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 = "Balloon-assisted enteroscopy, Capsule endoscopy, Left ventricular assist device, Small bowel bleeding",
author = "Badr Al-Bawardy and Schettle, {Sarah D.} and Emmanuel Gorospe and Song, {Louis M.Wong Kee} and Pereira, {Naveen Luke} and Alexander, {Jeffrey A.} and Bruining, {David H} and Nayantara Coelho-Prabhu and Fidler, {Jeff L.} and Mauermann, {William J.} and Barbara, {David W.} and Ross Dierkhising and Elizabeth Rajan",
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T1 - Small bowel bleeding in patients with left ventricular assist device

T2 - Outcomes of conservative therapy versus balloon-assisted enteroscopy

AU - Al-Bawardy, Badr

AU - Schettle, Sarah D.

AU - Gorospe, Emmanuel

AU - Song, Louis M.Wong Kee

AU - Pereira, Naveen Luke

AU - Alexander, Jeffrey A.

AU - Bruining, David H

AU - Coelho-Prabhu, Nayantara

AU - Fidler, Jeff L.

AU - Mauermann, William J.

AU - Barbara, David W.

AU - Dierkhising, Ross

AU - Rajan, Elizabeth

PY - 2018/10/20

Y1 - 2018/10/20

N2 - 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.

AB - 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.

KW - Balloon-assisted enteroscopy

KW - Capsule endoscopy

KW - Left ventricular assist device

KW - Small bowel bleeding

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