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Published on: August 16, 2021
Video capsule endoscopy is safe and effective in suspected small bowel bleeding among left ventricular assist device
David Itskoviz1,2, Ben Ben Avraham2,3, Hagar Banai1,2
11 Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel.
Insights
Small bowel capsule endoscopy is safe and effective for diagnosing bleeding in patients with left ventricular assist devices (LVADs). This minimally invasive procedure helps identify the source of gastrointestinal bleeding when other methods fail.
Area of Science:
- Gastroenterology
- Cardiology
- Medical Devices
Background:
- Small bowel bleeding is a common and challenging complication in patients with left ventricular assist devices (LVADs).
- Diagnostic yield and safety data for small bowel capsule endoscopy in LVAD recipients are limited.
Purpose of the Study:
- To evaluate the safety and efficacy of small bowel video capsule endoscopy (VCE) for investigating suspected small bowel bleeding in LVAD recipients.
Main Methods:
- A retrospective review identified 10 LVAD patients who underwent 12 VCE procedures for suspected small bowel bleeding.
- Suspected small bowel bleeding was defined as overt bleeding >30 days post-LVAD implantation without an identifiable cause on upper/lower endoscopy.
Main Results:
- No capsule retention or serious adverse events occurred in 12 VCE procedures.
- Significant findings were identified in 80% of patients, including angioectasias, ulcers, and polyps.
- Small bowel enteroscopy successfully treated bleeding angioectasias in two patients.
Conclusions:
- Small bowel capsule endoscopy is a safe and effective tool for diagnosing suspected small bowel bleeding in patients with left ventricular assist devices.
- VCE aids in identifying the source of obscure gastrointestinal bleeding in this high-risk population.
Introduction::
Suspected small bowel bleeding is frequently encountered in left ventricular assist device recipients and the identification of the culprit lesion may be challenging. Data regarding the safety and yield of small bowel capsule in the investigation of suspected small bowel bleeding are limited. We aimed to evaluate the safety and efficacy of small bowel video capsule endoscopy for the investigation of suspected small bowel bleeding among left ventricular assist device recipients.
Methods::
Patients with left ventricular assist device who underwent video capsule endoscopy for the investigation of suspected small bowel bleeding were identified. Suspected small bowel bleeding was defined as the presence of overt bleeding at least 30 days following left ventricular assist device implantation with no identifiable cause in upper and lower endoscopy.
Results::
A total of 10 patients with left ventricular assist device associated suspected small bowel bleeding performed 12 small bowel capsule endoscopies between January 2008 and December 2015 at our tertiary medical care facility. There were no cases of capsule retention or any other serious adverse events during the exams. A significant finding was identified in 8 out of 10 patients, including 3 cases of small bowel angioectasia, 2 cases of small bowel ulcers, 1 case of cecal polyp, and 2 cases of active bleeding with no apparent bleeding source. Small bowel enteroscopy identified and treated bleeding angioectasia in the latter two cases.
Conclusion::
Small bowel capsule endoscopy is safe and effective in the investigation of left ventricular assist device associated suspected small bowel bleeding.
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