Limited usefulness of endoscopic evaluation in patients with continuous-flow left ventricular assist devices and gastrointestinal bleeding

Jordan E. Axelrad, Alberto Pinsino, Pauline N. Trinh, Anusorn Thanataveerat, Christian Brooks, Ryan T. Demmer, Lisa Effner, Grant Parkis, Barbara Cagliostro, Jiho Han, A. Reshad Garan, Veli Topkara, Koji Takeda, Hiroo Takayama, Yoshifumi Naka, Ivonne Ramirez, Reuben Garcia-Carrasquillo, Paolo C. Colombo, Tamas Gonda, Melana Yuzefpolskaya

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Background: Gastrointestinal bleeding (GIB) is a frequent cause of re-admission in patients with continuous-flow left ventricular assist devices (CF-LVADs) and is associated with multiple endoscopic procedures and high resource utilization. Our aim was to determine the diagnostic and therapeutic yield of endoscopy and to develop a more cost-effective approach for the management of GIB in CF-LVAD recipients. Methods: We retrospectively reviewed 428 patients implanted with a CF-LVAD between 2009 and 2016 at the Columbia University Medical Center and identified those hospitalized for GIB. Patients were categorized into upper GIB (UGIB), lower GIB (LGIB) and occult GIB (OGIB), based on clinical presentation. Results: Eighty-seven CF-LVAD patients underwent a total of 164 GIBs, resulting in 239 endoscopies. Index presentation was consistent with UGIB in 30 (34.5%), LGIB in 19 (21.8%) and OGIB in 38 (43.7%) patients. On the first GIB, 147 endoscopies localized a bleeding source in 49 (30%), resulting in 24 (16.3%) endoscopic interventions. Of 45 lesions identified, arteriovenous malformations (AVMs) were the most common (22, 48.9%). A gastric or small bowel source (HR 2.8, p = 0.003) and an endoscopic intervention (HR 1.9, p = 0.04) predicted recurrent GIB. The proposed algorithm may reduce the number of endoscopic procedures by 45% and costs by 35%. Conclusions: Occult GIB is the most common presentation in CF-LVAD patients and carries the lowest diagnostic and therapeutic yield of endoscopy. Performing an intervention was among the strongest predictors of recurrent GIB. Our proposed algorithm may decrease the number of low-yield procedures and improve resource utilization.

Original languageEnglish (US)
Pages (from-to)723-732
Number of pages10
JournalJournal of Heart and Lung Transplantation
Volume37
Issue number6
DOIs
StatePublished - Jun 2018

Bibliographical note

Funding Information:
P.C.C. is recipient of a research grant from Abbott; he also serves as a consultant (with no honoraria) for the same company. Y.N. serves as a consultant for Abbott. The remaining authors have no conflicts of interest to disclose. This research was supported by the Lisa and Mark Schwartz Program to Reverse Heart Failure at New York–Presbyterian Hospital/Columbia University.

Publisher Copyright:
© 2018 International Society for the Heart and Lung Transplantation

Keywords

  • AVM, arterial venous malformations
  • CF-LVAD, continuous flow left ventricular assist device
  • LGIB, lower gastrointestinal bleeding
  • OGIB, occult gastrointestinal bleeding
  • UGIB, upper gastrointestinal bleeding

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