Early Implementation of Video Capsule Enteroscopy in Patients with Left Ventricular Assist Devices and Obscure Gastrointestinal Bleeding

Truss, Wiley; Weber, Frederick; Pamboukian, Salpy V.; Tripathi, Arvind; Peter, Shajan

doi:10.1097/mat.0000000000000303

Cited by 17 publications

(13 citation statements)

References 15 publications

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“…A large study in non-VAD patients demonstrated the importance of capsule endoscopy guidance for subsequent DBE, with lesions found during the first 60% of the capsule study better suited for upper DBE, and lesions during the last 40% better suited for lower DBE [ 13 ]. Additionally, we found capsule endoscopy to be safe in LVAD patients, with no complications related to VCE, no capsule retention, and no device interference, which is consistent with prior studies [ 12 , 14 , 15 ].…”

Section: Discussionsupporting

confidence: 90%

Efficacy of Video Capsule Endoscopy in the Management of Suspected Small Bowel Bleeding in Patients With Continuous Flow Left Ventricular Assist Devices

et al. 2017

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BackgroundContinuous flow left ventricular assist device (CF-LVAD) patients have a high prevalence of gastrointestinal bleeding from the small bowel. Video capsule endoscopy (VCE) is often used for diagnosis in these patients, but efficacy has yet to be determined. In this study, we evaluated the efficacy of VCE in the management of CF-LVAD patients with suspected small bowel bleeding by comparing to a non-VCE CF-LVAD control group.MethodsWe retrospectively reviewed the charts of all patients with CF-LVADs implanted at Stanford Hospital from January 2010 to October 2015. Patients were included in the study if there was a clinical suspicion of small bowel bleeding and either a negative upper endoscopy or colonoscopy.ResultsA total of 26 patients met inclusion criteria for a total of 15 encounters where VCE was done, and 25 where VCE was not done. There were no statistical differences when comparing these groups in terms of medical therapy use (thalidomide or octreotide), enteroscopy use (double-balloon or push), intervention on lesions, or any 30-day outcomes. There was no advantage to VCE with regard to the composite endpoint time to re-bleed or death related to re-bleeding (median 114 vs. 161 days, P = 0.15) after removing patients who did not get a VCE due to death or critical illness.ConclusionsWe did not find VCE changed management or outcomes in CF-LVAD patients with suspected small bowel bleeding at our institution when compared to a non-VCE control group. Our experience is small and single center, and larger, multi-center studies could further elucidate the utility of VCE in this patient population.

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Section: Discussionsupporting

confidence: 90%

Efficacy of Video Capsule Endoscopy in the Management of Suspected Small Bowel Bleeding in Patients With Continuous Flow Left Ventricular Assist Devices

et al. 2017

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“…[31, 32] The diagnostic yield of capsule endoscopy has been noted to be as low as 20% [14] and as high as 100% in the LVAD population. [33] When capsule endoscopy is abnormal, the most frequent finding is blood in the lumen of the gastrointestinal tract. However, the culprit lesion is directly visualized less than 25% of the time.…”

Section: Resultsmentioning

confidence: 99%

“…However, the culprit lesion is directly visualized less than 25% of the time. [33] This suggests capsule endoscopy can help localize the site of bleeding with VCE but may not visualize the principal bleeding angiodysplasia.…”

Section: Resultsmentioning

confidence: 99%

Gastrointestinal Bleeding Following LVAD Placement from Top to Bottom

Cushing

Kushnir

2016

Dig Dis Sci

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Left ventricular assist devices (LVADs) are an increasingly prevalent form of mechanical support for patients with end-stage heart failure. These devices can be implanted both as a bridge to transplant or definitive/destination therapy. Gastrointestinal (GI) bleeding is one of the most common and recalcitrant long-term complications following LVAD implantation, with an incidence approaching 30%. The pathophysiology of bleeding is multifactorial, with hemodynamic alterations, acquired von Willebrand factor deficiency, and coagulopathy being most often implicated. The majority of bleeding events in this population result from angioectasias and gastro-duodenal erosive disease. While these bleeding events are significant and often require transfusion therapy, they are rarely life threatening. Endoscopy remains the standard of care with upper endoscopy offering the highest diagnostic yield in these patients. However, the effectiveness of endoscopic hemostasis in this population is not well established. A small number of studies have evaluated medical therapy and alterations in LVAD settings as a means of preventing or treating bleeding with variable results. In summary, GI bleeding with LVADs is a common occurrence and will continue to be as more LVADs are being performed for destination therapy. This review will discuss what is known about the pathophysiology of GI bleeding in LVADs and the currently available options for medical and/or endoscopic management.

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“…Nevertheless, users of VCE estimated EMI between capsules and cardiac devices possibly being life-threatening for patients. Since the introduction of VCE, several in vitro and in vivo studies analyzed EMI between VCE (PillCam and EndoCapsule) and PMs ( in vitro :[42-44]; in vivo :[44-54]), implantable cardioverter defibrillators (ICD) ( in vitro :[55,56]; in vivo :[45-48,54,56-59]) and left ventricular assist devices (LVAD) ( in vitro : none, in vivo :[52,60-68]).…”

Section: Vce In Patients With Implantable Cardiac Devicesmentioning

confidence: 99%

“…EMI between VCE and LVAD was investigated in 10 in-vivo studies[52,60-68]. No interference was observed in any of the studies.…”

Section: Vce In Patients With Implantable Cardiac Devicesmentioning

confidence: 99%

Contraindications for video capsule endoscopy

Bandorski¹,

Kurniawan²,

Baltes³

et al. 2016

WJG

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Video capsule endoscopy (VCE) has been applied in the last 15 years in an increasing field of applications. Although many contraindications have been put into perspective, some precautions still have to be considered. Known stenosis of the gastrointestinal tract is a clear contraindication for VCE unless surgery is already scheduled or at least has been considered as an optional treatment modality. In patients with a higher incidence of stenosis, as in an established diagnosis of Crohn’s disease, clinical signs of obstruction, prior radiation or surgical small bowel resection, a preceding test with the self-dissolving patency capsule can override this contraindication. Endoscopic placement of the capsule should be considered in patients with swallowing disorders to avoid aspiration. Esophageal or gastric motility disorders may require endoscopic capsule transport or application of prokinetics if the real-time viewer proofs delayed transit. In pregnant women, VCE should be restricted to urgent cases where diagnosis cannot be postponed after delivery, as data on safety are missing. There is theoretical and clinical evidence that patients with implanted cardiac devices such as a pacemaker, cardioverters or left heart assist devices, can safely undergo VCE in spite of still existing contraindication by manufacturers. Children from the age of 2 years have safely undergone VCE. Although video capsules are not proven safe with magnetic resonance imaging (MRI), first single cases of patients incidentally undergoing MRI with an incorporated capsule have been reported, showing susceptibility artifacts but no signs of clinical harm.

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Early Implementation of Video Capsule Enteroscopy in Patients with Left Ventricular Assist Devices and Obscure Gastrointestinal Bleeding

Cited by 17 publications

References 15 publications

Efficacy of Video Capsule Endoscopy in the Management of Suspected Small Bowel Bleeding in Patients With Continuous Flow Left Ventricular Assist Devices

Efficacy of Video Capsule Endoscopy in the Management of Suspected Small Bowel Bleeding in Patients With Continuous Flow Left Ventricular Assist Devices

Gastrointestinal Bleeding Following LVAD Placement from Top to Bottom

Contraindications for video capsule endoscopy

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