Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2021; 27(25): 3877-3887
Published online Jul 7, 2021. doi: 10.3748/wjg.v27.i25.3877
Does endoscopic intervention prevent subsequent gastrointestinal bleeding in patients with left ventricular assist devices? A retrospective study
Sonali Palchaudhuri, Ishita Dhawan, Afshin Parsikia, Edo Y Birati, Joyce Wald, Shazia Mehmood Siddique, Laurel R Fisher
Sonali Palchaudhuri, Ishita Dhawan, Afshin Parsikia, Shazia Mehmood Siddique, Laurel R Fisher, Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA 19104, United States
Edo Y Birati, Joyce Wald, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
Author contributions: Fisher LR and Siddique SM contributed equally to this work; Palchaudhuri S, Siddique SM, and Fisher LR designed the research study; Birati EY, Wald J, Palchaudhuri S, Dhawan I, and Parsikia A sourced and collected the data; Palchaudhuri S analyzed the data and wrote the manuscript; All authors read, made revisions, and approved the final manuscript.
Supported by National Institute of Diabetes and Digestive and Kidney Diseases, No. T32DK007740 and No. K08DK120902.
Institutional review board statement: This project was reviewed and determined to qualify as Quality Improvement by the University of Pennsylvania’s Institutional Review Board.
Conflict-of-interest statement: Birati EY is recipient of research grants through the University from Impulse Dynamics and Medtronic. No relevant conflicts of interest to this manuscript; Fisher L site principle investigator for a Medtronic trial regarding video capsule endoscopy, but not related to LVADs. No relevant conflicts of interest to this manuscript; No disclosures or COI for the other authors.
Data sharing statement: Statistical code and dataset are available from the corresponding author at sonalipalchaudhuri@gmail.com
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Sonali Palchaudhuri, MD, Attending Doctor, Division of Gastroenterology and Hepatology, University of Pennsylvania, 3400 Civic Center Boulevard South Pavilion, 4th Floor, Philadelphia, PA 19104, United States. sonali@post.harvard.edu
Received: February 14, 2021
Peer-review started: February 14, 2021
First decision: March 14, 2021
Revised: April 19, 2021
Accepted: June 2, 2021
Article in press: June 2, 2021
Published online: July 7, 2021
Processing time: 141 Days and 3.8 Hours
Abstract
BACKGROUND

Patients with left ventricular assist devices (LVADs) are at increased risk for recurrent gastrointestinal bleeding (GIB) and repeat endoscopic procedures. We assessed the frequency of endoscopy for GIB in patients with LVADs and the impact of endoscopic intervention on preventing a subsequent GIB.

AIM

To evaluate for an association between endoscopic intervention and subsequent GIB. Secondary aims were to assess the frequency of GIB in our cohort, describe GIB presentations and sources identified, and determine risk factors for recurrent GIB.

METHODS

We conducted a retrospective cohort study of all patients at a large academic institution who underwent LVAD implantation from January 2011 – December 2018 and assessed all hospital encounters for GIB through December 2019. We performed a descriptive analysis of the GIB burden and the outcome of endoscopic procedures performed. We performed multivariate logistic regression to evaluate the association between endoscopic intervention and subsequent GIB.

RESULTS

In the cohort of 295 patients, 97 (32.9%) had at least one GIB hospital encounter. There were 238 hospital encounters, with 55.4% (132/238) within the first year of LVAD implantation. GIB resolved on its own by discharge in 69.8% (164/235) encounters. Recurrent GIB occurred in 55.5% (54/97) of patients, accounting for 59.2% (141/238) of all encounters. Of the 85.7% (204/238) of encounters that included at least one endoscopic evaluation, an endoscopic intervention was performed in 34.8% (71/204). The adjusted odds ratio for subsequent GIB if an endoscopic intervention was performed during a GIB encounter was not significant (odds ratio 1.18, P = 0.58).

CONCLUSION

Patients implanted with LVADs whom experience recurrent GIB frequently undergo repeat admissions and endoscopic procedures. In this retrospective cohort study, adherence to endoscopic guidelines for performing endoscopic interventions did not significantly decrease the odds of subsequent GIB, thus suggesting the uniqueness of the LVAD population. A prospective study is needed to identify patients with LVAD at risk of recurrent GIB and determine more effective management strategies.

Keywords: Gastrointestinal bleeding; Left ventricular-assist device; Endoscopic intervention, Inpatient care; Hospital readmissions; Recurrent bleeding

Core Tip: Patients implanted with left ventricular assist devices (LVADs) whom experience recurrent gastrointestinal bleeding (GIB) frequently undergo repeat admissions and endoscopic procedures. In this retrospective cohort study, a majority of GIB resolved by discharge without intervention and adherence to endoscopic guidelines for performing endoscopic interventions did not significantly decrease the odds of subsequent GIB, thus questioning the role of endoscopy in this population. A prospective study is needed to identify patients with LVAD patients at risk of recurrent GIB and determine more effective management strategies.