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Does endoscopic intervention prevent subsequent gastrointestinal bleeding in patients with left ventricular assist
Sonali Palchaudhuri1, Ishita Dhawan2, Afshin Parsikia2
1Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA 19104, United States. sonali@post.harvard.edu.
Insights
Patients with left ventricular assist devices (LVADs) often experience recurrent gastrointestinal bleeding (GIB). Endoscopic interventions during GIB episodes did not significantly reduce the risk of subsequent bleeding in this population.
Area of Science:
- Cardiology
- Gastroenterology
- Medical Devices
Background:
- Patients with left ventricular assist devices (LVADs) face a heightened risk of recurrent gastrointestinal bleeding (GIB).
- Repeat endoscopic procedures are common for managing GIB in LVAD recipients.
Purpose of the Study:
- To assess the association between endoscopic intervention and subsequent GIB in LVAD patients.
- To determine the frequency, presentation, and risk factors of GIB in this cohort.
Main Methods:
- Retrospective cohort study of 295 LVAD patients from January 2011 to December 2018.
- Analysis of hospital encounters for GIB through December 2019.
- Multivariate logistic regression to evaluate the impact of endoscopic intervention on recurrent GIB.
Main Results:
- 32.9% of patients experienced at least one GIB hospital encounter.
- Recurrent GIB occurred in 55.5% of patients.
- Endoscopic intervention during a GIB episode did not significantly reduce the odds of subsequent GIB (OR 1.18, P=0.58).
Conclusions:
- LVAD patients with recurrent GIB frequently require re-admissions and endoscopic interventions.
- Current endoscopic intervention guidelines did not significantly decrease subsequent GIB risk in LVAD patients.
- Prospective studies are needed to identify risk factors and develop effective management strategies for GIB in LVAD recipients.
Background:
Patients with left ventricular assist devices (LVADs) are at increased risk for recurrent gastrointestinal bleeding (GIB) and repeat endoscopic procedures. We assessed the frequency of endoscopy for GIB in patients with LVADs and the impact of endoscopic intervention on preventing a subsequent GIB.
Aim:
To evaluate for an association between endoscopic intervention and subsequent GIB. Secondary aims were to assess the frequency of GIB in our cohort, describe GIB presentations and sources identified, and determine risk factors for recurrent GIB.
Methods:
We conducted a retrospective cohort study of all patients at a large academic institution who underwent LVAD implantation from January 2011 - December 2018 and assessed all hospital encounters for GIB through December 2019. We performed a descriptive analysis of the GIB burden and the outcome of endoscopic procedures performed. We performed multivariate logistic regression to evaluate the association between endoscopic intervention and subsequent GIB.
Results:
In the cohort of 295 patients, 97 (32.9%) had at least one GIB hospital encounter. There were 238 hospital encounters, with 55.4% (132/238) within the first year of LVAD implantation. GIB resolved on its own by discharge in 69.8% (164/235) encounters. Recurrent GIB occurred in 55.5% (54/97) of patients, accounting for 59.2% (141/238) of all encounters. Of the 85.7% (204/238) of encounters that included at least one endoscopic evaluation, an endoscopic intervention was performed in 34.8% (71/204). The adjusted odds ratio for subsequent GIB if an endoscopic intervention was performed during a GIB encounter was not significant (odds ratio 1.18, P = 0.58).
Conclusion:
Patients implanted with LVADs whom experience recurrent GIB frequently undergo repeat admissions and endoscopic procedures. In this retrospective cohort study, adherence to endoscopic guidelines for performing endoscopic interventions did not significantly decrease the odds of subsequent GIB, thus suggesting the uniqueness of the LVAD population. A prospective study is needed to identify patients with LVAD at risk of recurrent GIB and determine more effective management strategies.
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