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 L. 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

    Fingerprint

Keywords

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

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Al-Bawardy, B., Schettle, S. D., Gorospe, E., Song, L. M. W. K., 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