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Endoscopic Algorithm for Management of Gastrointestinal Bleeding in Patients With Continuous Flow LVADs: A
Jordan E Axelrad1, Adam S Faye2, Alberto Pinsino3
1Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, New York, New York; Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, New York.
A new endoscopic algorithm for gastrointestinal bleeding (GIB) in left ventricular assist device (LVAD) patients significantly improved diagnostic yield and reduced procedures and costs. This approach effectively managed GIB without increasing re-bleeding risks.
Area of Science:
- Cardiology
- Gastroenterology
- Medical Devices
Background:
- Gastrointestinal bleeding (GIB) is a frequent complication in patients with left ventricular assist device (LVAD) therapy.
- GIB in LVAD patients leads to significant hospitalizations and high healthcare resource utilization.
Purpose of the Study:
- To evaluate an endoscopic management algorithm for GIB in LVAD recipients.
- To compare the diagnostic and therapeutic yield, healthcare costs, and re-bleeding rates of the new algorithm versus conventional GIB management.
Main Methods:
- A cohort of 33 LVAD patients with GIB was analyzed.
- An endoscopic algorithm prioritizing small bowel evaluation and minimizing low-yield procedures was implemented.
- Diagnostic and therapeutic yields, costs, and re-bleeding rates were compared between the algorithm and conventional management groups using statistical analyses.
Main Results:
- Algorithm implementation increased endoscopic diagnostic yield by 68% (P< .01) and therapeutic yield by 113% (P= .01).
- The algorithm reduced procedures per patient by 27% (P < .01), length of stay by 33% (P < .01), and estimated costs by 18% (P < .01).
- No significant increase in re-bleeding events was observed in the algorithm group compared to the conventional group.
Conclusions:
- The developed endoscopic management algorithm is effective for GIB in LVAD patients.
- The algorithm improves diagnostic and therapeutic endoscopy yields while reducing low-yield procedures.
- This approach decreases healthcare resource utilization and costs without elevating re-bleeding risk.
