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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.

periods. Although CE has a risk of overestimation, we should monitor the disease activity regularly and optimize medical treatments appropriately, which might lead to a better postoperative course.

ing, diarrhea or perianal pain. He was a long-term cigarette smoker with a 20 pack-year history. The abdominal CT on admission demonstrated multiple dilated distal loops of small bowel with an abnormally thickened and enhanced wall, suggesting partial small bowel obstruction with suspicion of inflammatory bowel disease. Some oral contrast traversed the small bowel into the colon. The patient was admitted to the surgical service with presumptive diagnosis of narcotic bowel syndrome versus partial small bowel obstruction from another inflammatory process or adhesions. Gastroenterology was consulted and based upon the CT results, an elevated CRP of 4.5 mg/dl and a low vitamin D level, the diagnosis of Crohn's disease was strongly considered. Colonoscopy was recommended before considering surgical intervention. Initial attempts at a bowel prep failed and after bowel rest for 6 days and initiation of TPN, a prep and colonoscopy were able to be performed. The findings included pseudopolyps in the sigmoid colon, extensive erosions throughout the colon and terminal ileitis. Pathology confirmed active ileitis and colitis without granulomas. The patient was started on steroids with significant and rapid improvement. One week later, the patient had regained his appetite, was having 1 bowel movement per day and was abdominal pain free. Finally he is off of narcotics. He stopped smoking as well. Discussion: Narcotic addiction is a severe problem in the USA, and frequently results in the narcotic bowel syndrome. This often presents a clinical challenge as the signs and symptoms can be often confused with partial or complete small bowel obstruction. Physicians in general are more aware of this syndrome, but should still remain alert in ruling out other organic diseases as the cause of the patient's symptoms. In some patients like ours, determining another cause for the patient's symptoms may stop the vicious cycle of narcotic addiction.BACKGROUND: Inflammatory Bowel Disease (IBD) patients, particularly those with steroid-refractory disease requiring chronic immunosuppressive therapy, are at a higher risk for developing Cytomegalovirus (CMV) colitis. This case describes a patient with probable reactivation CMV colitis in an immune competent patient with prior mild ulcerative colitis. METHODS: Clinical Case Report. RESULTS: Patient JD is a 39 year old male with a history of depression and chronic low back pain who presented with a 6 to 9 month history of bloating, foul smelling flatus, and several weeks of hematochezia. He had no past abdominal surgeries and no family history of colon cancer or IBD. Initial labs included a negative celiac panel, normal TSH, and a normal CBC. Flexible sigmoidoscopy revealed a rectum with moderate, diffuse inflammation, erythema, edema, friability, and ulceration. This was only present in the last 2 centimeters examined on sigmoidoscopy. Biopsies showed marked acute inflammation with numerous crypt abscesses and destruction, architectural disorder, and basal plasmacytosis consistent with acute on c...

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