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Outcomes in Patients with Left Ventricular Assist Devices, Pacemakers, and Implantable Cardioverter Defibrillators
Brijesh Patel1, Ashok Shiani1, Andrea C Rodriguez1
1From the Departments of Digestive Diseases and Nutrition, Internal Medicine, and Evidence-Based Medicine and Research Outcomes, University of South Florida, Tampa.
Insights
Single balloon enteroscopy (SBE) is safe and effective for evaluating obscure gastrointestinal bleeding in patients with cardiac devices, including left ventricular assist devices (LVADs), pacemakers (PPMs), and implantable cardioverter defibrillators (ICDs). Outcomes are comparable to patients without cardiac devices.
Area of Science:
- Gastroenterology
- Cardiology
- Medical Devices
Background:
- Obscure overt gastrointestinal bleeding presents diagnostic challenges in patients with electronic cardiac devices.
- Limited data exist on the safety and utility of single balloon enteroscopy (SBE) in this patient population.
Purpose of the Study:
- To evaluate the safety, efficacy, diagnostic, and therapeutic outcomes of SBE in patients with cardiac devices (LVADs, PPMs, ICDs).
Main Methods:
- Retrospective study of 57 patients undergoing SBE (2010-2014).
- Patients were divided into two groups: those with cardiac devices (n=19) and those without (n=38).
- Comparison of comorbidities, complications, findings, diagnostic/therapeutic yield, and rebleeding rates using t-tests and logistic regression.
Main Results:
- No statistically significant differences in hospitalization rates, procedure times, or major/minor adverse events between groups.
- Diagnostic and therapeutic yield were similar in patients with and without cardiac devices.
- Rebleeding rates were also comparable across both groups.
Conclusions:
- Single balloon enteroscopy (SBE) is a safe and effective procedure for evaluating obscure gastrointestinal bleeding in patients with cardiac devices.
- Patients with cardiac devices undergoing SBE experience outcomes similar to those without devices.
- Clinicians can confidently perform SBE in patients with LVADs, PPMs, and ICDs.
Objectives:
Obscure overt gastrointestinal bleeding can be challenging to evaluate in patients with electronic cardiac devices such as continuous flow left ventricular assist devices (LVADs), pacemakers (PPMs), and implantable cardioverter defibrillators (ICDs). Limited data exist on the utility and safety of single balloon enteroscopy (SBE) in patients with cardiac devices. We aimed to evaluate the safety, efficacy, diagnostic, and therapeutic outcomes of the aforementioned devices in patients undergoing SBE.
Methods:
A retrospective study was performed using the medical records of 57 patients undergoing SBE at our institution from 2010 to 2014. Patients were divided into two groups: those with cardiac devices and those without. Data on comorbidities, complications, findings, diagnostic, and therapeutic yield were compared. t Test and logistic regression assessed the association between dependent and independent variables. For continuous data, the results were summarized as mean difference and standard deviation. For dichotomous data, the results were summarized as odds ratio and 95% confidence intervals.
Results:
The overall age in patients with cardiac devices was 67.89 ± 6.96 versus 66.03 ± 11.95 years in the control. The cardiac device group was composed of 42.1% women; the control comprised 21.1% women. There were 19 patients with cardiac devices; 8 (LVAD + ICD), 1 (LVAD + PPM + ICD), 2 (PPM + ICD), 6 (PPM), 2 (ICD); 38 patients were in the control group. Patients with cardiac devices were hospitalized more often than patients without devices; this finding was not statistically significant (odds ratio 1.826, 95% confidence interval 0.544-6.128, P = 0.389). Procedure times were longer in the cardiac device group, 65.16 ± 49.92 minutes, when compared with the control, 57.40 ± 20.42, but it also did not reach statistical significance (mean difference 7.758, 95% confidence interval -11.360 to 26.876, P = 0.049). There was no statistically significant difference in major or minor events between patients with cardiac devices and the control group. Diagnostic and therapeutic yield and rebleeding rates were similar across both groups.
Conclusions:
Patients in the cardiac device group did not appear to be at any more significant risk than those without cardiac devices. Furthermore, diagnostic and therapeutic yield and rebleeding rates appear to be similar across both groups. Clinicians may perform SBE in these patients safely and effectively, with good overall outcomes.
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