No 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.

No abstract

No abstract

Background: The hospitalization rates of patients with pulmonary embolism (PE) has been on the rise. However, there is limited data recognizing the etiologies and predictors of early readmission rate in this patient population. Methods: We utilized the National Readmission Database (NRD) 2013, subset of the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality (AHRQ). PE was identified using ICD 9 code (415.1X) as primary diagnosis. Co-morbidities identified by “CM_” variables provided by NRD. Primary outcome was identified as predictors of 30-day readmission rates and secondary outcomes as the leading etiologies and trends of readmission rate. To identify predictors of outcome, a two level hierarchical logistical model was used. Results: We analyzed 76,994 patients with primary diagnosis of PE. Total of 11.6% (8,934) patients were readmitted within 30 days of index hospitalization. Significant predictors of readmission were associated with end stage renal disease, drug abuse, chronic lung disease, congestive heart failure, and gastrointestinal bleed during primary admission. In addition, female gender, those admitted to teaching hospital and with longer length of stay (LOS) had higher 30-day readmission rate. Remarkably, elderly age (age>75 years) was not associated with increase in readmission rates. The leading etiologies besides DVT/PE for readmission were sepsis/septic shock, cancer, heart failure and pneumonia. Conclusion: The rising hospitalization rate of patients with pulmonary embolism, imposes a higher burden on the cost of health care. We identified important predictors and etiologies of 30-day readmission rate. These findings may help in prevention of hospital readmissions and may decrease the cost of care.