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

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.

Use of device-assisted enteroscopy in small bowel disease: an expert consensus statement by the Korean Association for the Study of Intestinal Diseases

“…A previous prospective study of 60 patients with SBB reported a therapeutic yield of 57% [ 118 ]. A recent multicenter retrospective cohort study reported a 67.4% therapeutic yield [ 119 ]. In another study considering the timing of endoscopy, earlier enteroscopy had a higher therapeutic yield (100%, 76.9%, and 57.7% at ≤24, ≤48, and ≤72 hours, respectively) [ 120 ].…”

“…118 A recent multicenter retrospective cohort study reported a 67.4% therapeutic yield. 119 In another study considering the timing of endoscopy, earlier enteroscopy had a higher therapeutic yield (100%, 76.9%, and 57.7% at ≤ 24, ≤ 48, and ≤ 72 hours, respectively). 120 Therefore, endoscopic hemostasis is recommended for various SB lesions such as bleeding lesions (ulcers or erosions), vascular lesions (angioectasia or Dieulafoy lesions), tumors, and diverticula.…”

Tips for successful deep enteroscopy

“…Deep enteroscopy is frequently requested on patients with severe heart disease or implanted cardiac devices. With proper precautions, these procedures are generally well tolerated to perform [6]. In fact, we prefer to perform enteroscopic investigations for these patients with obscure bleeding because of the higher likelihood of finding actively bleeding lesions [7 ▪▪ ].…”

Hemorragia de intestino medio, ¿qué hemos avanzado?

“…Los pacientes renales tuvieron una mayor incidencia de resangrado (81 vs. 22%) y necesidad de realizar nuevos estudios y la conclusión es que los pacientes renales tienen mayor frecuencia de resangrados y de transfusiones a pesar de la EAD. Hasan 9 presentó en un estudio multicéntrico retrospectivo sobre la utilidad y seguridad de la EAD en los pacientes con dispositivos de asistencia ventricular izquierda e incluyo a 34 pacientes de los cuales 20 estaban con antiagregantes plaquetarios y 24 con Warfarina, y todos tenían evaluación preanestésica clase IV y no hubo complicaciones anestésicas ni endoscópicas. El alcance diagnóstico fue del 69% para la EMB, 73% para la EDB y 55% para la espiral y el alcance terapéutico respectivamente fue de 67, 73 y 44%.…”