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

Abstract

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.

Gastrointestinal bleeding in patients with continuous‐flow left ventricular assist devices: A comprehensive review

“…All these modalities have been studied in CF‐LVAD patients and found to be safe. Video capsule endoscopy has a diagnostic yield of 33%–40% in LVAD patients with obscure GIB 48 . They are 56% more effective in identifying clinically significant lesions than push enteroscopy at only 26% or small bowel follow‐through at 6% 49 .…”

“…Video capsule endoscopy has a diagnostic yield of 33%-40% in LVAD patients with obscure GIB. 48 They are 56% more effective in identifying clinically significant lesions than push enteroscopy at only 26% or small bowel follow-through at 6%. 49 Those capsules may even detect more bleeding source lesions than computed tomography and angiography (72% vs. 24% and 56%, respectively).…”