Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2016; 22(18): 4559-4566
Published online May 14, 2016. doi: 10.3748/wjg.v22.i18.4559
Video capsule endoscopy in left ventricular assist device recipients with obscure gastrointestinal bleeding
Surachai Amornsawadwattana, Michael Nassif, David Raymer, Shane LaRue, Chien-Huan Chen
Surachai Amornsawadwattana, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, United States
Michael Nassif, David Raymer, Shane LaRue, Division of Cardiology, Washington University School of Medicine, St. Louis, MO 63110, United States
Chien-Huan Chen, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO 63110, United States
Author contributions: Amornsawadwattana S designed the study, collected and analyzed data and drafted the manuscript; Nassif M, Raymer D and LaRue S provided and collected data and revised the manuscript; Chen CH analyzed data, supervised the study and revised the manuscript.
Institutional review board statement: This study was reviewed and approved by the Washington University School of Medicine Institutional Review Board.
Informed consent statement: All participants were waived of written informed consent in this study.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chien-Huan Chen, MD, PhD, Associate Professor of Medicine, Division of Gastroenterology, Department of Internal Medicine, Washington University School of Medicine, Campus Box 8124, 660 South Euclid Ave, St Louis, MO 63110, United States. cchen@dom.wustl.edu
Telephone: +1-314-4547813 Fax: +1-314-7475871
Received: December 17, 2015
Peer-review started: December 19, 2015
First decision: January 13, 2016
Revised: February 17, 2016
Accepted: March 13, 2016
Article in press: March 14, 2016
Published online: May 14, 2016
Processing time: 139 Days and 1.8 Hours
Abstract

AIM: To assess whether video capsule endoscopy (VCE) affects the outcomes of left ventricular assist devices (LVADs) recipients with gastrointestinal bleeding.

METHODS: This is a retrospective study of LVAD recipients with obscure gastrointestinal bleeding (OGIB) who underwent VCE at a tertiary medical center between 2005 and 2013. All patients were admitted and monitored with telemetry and all VCE and subsequent endoscopic procedures were performed as inpatients. A VCE study was considered positive only when P2 lesions were found and was regarded as negative if P1 or P0 were identified. All patients were followed until heart transplant, death, or the end of the study.

RESULTS: Between 2005 and 2013, 30 patients with LVAD underwent VCE. Completion rate of VCE was 93.3% and there was no capsule retention. No interference of VCE recording or the function of LVAD was found. VCE was positive in 40% of patients (n = 12). The most common finding was active small intestinal bleeding (50%) and small intestinal angiodysplasia (33.3%). There was no difference in the rate of recurrent bleeding between patients with positive and negative VCE study (50.0% vs 55.6%, P = 1.00) during an average of 11.6 ± 9.6 mo follow up. Among patients with positive VCE, the recurrent bleeding rate did not differ whether subsequent endoscopy was performed (50% vs 50%, P = 1.00).

CONCLUSION: VCE can be safely performed in LVAD recipients with a diagnostic yield of 40%. VCE does not affect recurrent bleeding in LVAD patients regardless of findings.

Keywords: Heart-assist devices; Capsule endoscopy; Gastrointestinal hemorrhage; Heart failure; Endoscopy; Digestive system

Core tip: Obscure gastrointestinal bleeding (OGIB) is a common complication for patients receiving left ventricular assist device (LVAD). Although video capsule endoscopy (VCE) is frequently used to investigate OGIB, there is limited data on the safety and usefulness of VCE in LVAD recipients. We found that VCE can be safely performed in LVAD recipients with OGIB and with a 40% diagnostic yield. However, the results of VCE and the subsequent management driven by VCE did not affect the rate of recurrent GIB. Endoscopic intervention thus should be used judiciously, and alternative ways of management should be considered in LVAD patients with OGIB.