Utility and safety of balloon-assisted enteroscopy in patients with left ventricular assist devices: a retrospective multicenter study

Badar M. Hasan; Charles McMahon; Rumman A. Khalid; Yasar Colak; Daniel C. Mayorga; Ahmed Elkafrawy; Kanwarpreet Tandon; Muhammad Shafiq; Ishtiaq Hussain; Tolga Erim; Fernando Castro; Roger Charles; Rajiv Chhabra

doi:10.1055/a-1181-8340

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(08): E1002-E1008
DOI: 10.1055/a-1181-8340

Original article

Utility and safety of balloon-assisted enteroscopy in patients with left ventricular assist devices: a retrospective multicenter study

Authors

Badar M. Hasan

¹Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, United States
Charles McMahon

²Department of Internal Medicine, Division of Gastroenterology, Loyola University Medical Center, Chicago, Illinois, United States
Rumman A. Khalid

¹Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, United States
Yasar Colak

¹Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, United States
Daniel C. Mayorga

¹Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, United States
Ahmed Elkafrawy

⁴Department of Gastroenterology and Hepatology, Saint Lukeʼs Hospital of Kansas City/University of Missouri Kansas City (UMKC), Missouri, United States
Kanwarpreet Tandon

¹Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, United States
Muhammad Shafiq

³Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, United States
Ishtiaq Hussain

¹Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, United States
Tolga Erim

¹Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, United States
Fernando Castro

¹Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, United States
Roger Charles

¹Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, United States
Rajiv Chhabra

⁴Department of Gastroenterology and Hepatology, Saint Lukeʼs Hospital of Kansas City/University of Missouri Kansas City (UMKC), Missouri, United States

Abstract

Objective and study aims Patients with left-ventricular assist devices (LVADs) have an increased risk of gastrointestinal bleeding, especially from the small bowel, often necessitating evaluation with balloon-assisted enteroscopy (BAE). Our study aimed to assess the periprocedural safety and utility of BAE for gastrointestinal bleeding in patients with LVADs.

Patients and methods This was a multicenter retrospective cohort study of adults with LVADs who underwent BAE between January 2007 to December 2018.

Results Thirty-four patients underwent a total of 46 BAEs (9 were single-balloon enteroscopies [SBEs] and 37 were double-balloon enteroscopies [DBEs]). Mean age of patients was 66.4 ± 8.3 years. Patients tolerated anesthesia well, without complications. There were no complications from the BAE itself. One patient required repeat BAE due to a progressive drop in hemoglobin and another patient developed paroxysmal supraventricular tachycardia. One patient died within 72 hours of the procedure due to worsening of LVAD thrombosis. Diagnostic yields were 69.6 % for all procedures, 73.0 % for DBE and 55.6 % for SBE (P = 0.309). Therapeutic yields were 67.4 % overall: 73.0 % for DBE and 44.4 % for SBE (P = 0.102). In those that presented with overt gastrointestinal bleeding, DBE had a higher diagnostic yield compared to SBE (84.2 % vs. 42.9 %; P = 0.057) and a significantly higher therapeutic yield (84.2 % vs. 28.6 %; p = 0.014).

Conclusions This is the largest multicenter study of patients with LVADs who underwent DBE. BAE appears to be a safe and useful modality for the evaluation of gastrointestinal bleeding in these patients.

Full Text

References

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