Does endoscopic intervention prevent subsequent gastrointestinal bleeding in patients with left ventricular assist devices? A retrospective study

Table 1 Comparative characteristics of patients with left ventricular assistant devices with gastrointestinal bleeding vs no gastrointestinal bleeding, n (%)

Factor		No GIB	At least 1 GIB	P value
n		198	97
Age implant, median (IQR)		56.9 (46.9, 67.0)	60.8 (52.7, 69.8)	0.014
Sex (male)		160 (81.2)	82 (84.5)	0.52
Race	White	113 (57.1)	58 (59.8)	0.067
	Black	54 (27.3)	31 (32.0)
	Asian	0 (0.0)	1 (1.0)
	Other	12 (6.1)	5 (5.2)
	Unknown	19 (9.6)	2 (2.1)
Type of LVAD	Heartware	66 (33.3)	27 (27.8)	0.22
	HeartMate 2	114 (57.6)	55 (56.7)
	HeartMate3	18 (9.1)	15 (15.5)
LVAD purpose	Destination (DT)	113 (57.1)	70 (72.2)	0.030
	bridge to transplant (BTT)	80 (40.4)	25 (25.8%)
	Bridge to Recovery (BTR)	5 (2.5)	2 (2.1)
LVAD exposure (d) (IQR)		348 (103, 947)	895 (520, 1433)	< 0.001

The following statistical tests were utilized: Wilcoxon rank-sum test [age, left ventricular-assist device(LVAD)], and Fisher’s exact test (sex, race, type of LVAD, LVAD purpose). GIB: gastrointestinal bleeding; IQR: Interquartile range; LVAD: Left ventricular-assist device.

Table 2 Lesion types and interventions used in endoscopic procedures with interventions, n (%).

Category		n (%)
Type of intervention	APC	37 (51.4)
	Hemoclip	31 (43.1)
	Injection	23 (31.9)
	Bipolar	16 (22.2)
Culprit lesion	Ulcer	8 (11.1)
	Angioectasia	34 (47.2)
	Dieulafoy	3 (4.2)
	Non-specific oozing	14 (19.4)
	Other/uncharacterized	13 (18.1)

Sum of percentages is greater than 100% as some procedures involved multiple interventions. One encounter had two lesions. APC: Argon plasma coagulation.

Table 3 Comparative characteristics of gastrointestinal bleeding encounters with a subsequent gastrointestinal bleeding vs no subsequent gastrointestinal bleeding, n (%)

Factor		No subsequent GIB	Had a subsequent GIB	P value
n		97	141
Change in anticoagulation		56 (64.4)	87 (65.4)	0.89
Overt bleed		75 (78.9)	102 (73.4)	0.36
Hemoglobin, median (IQR)		7.8 (6.8, 9.1)	7.5 (6.2, 8.4)	0.043
Source identified		51 (52.6)	79 (56.0)	0.69
Culprit lesion	Ulcer	3 (11)	5 (11)	1.00
	Angioectasia	13 (48)	21 (48)
	Dieulafoy	1 (4)	2 (5)
	Non-specific oozing	5 (19)	9 (20)
	Other	5 (19)	7 (16)
Culprit lesion location	Esophagus	2 (2.2)	0 (0.0)	0.38
	Stomach	24 (25.8)	30 (22.6)
	Duodenum	6 (6.5)	11 (8.3)
	Deep small bowel	12 (12.9)	28 (21.1)
	Colon	7 (7.5)	10 (7.5)
	Not identified	42 (45.2)	54 (40.6)
Endoscopic intervention performed		27 (27.8)	44 (31.2)	0.58
Days to first endoscopic study (mean ± SD)		3.4 ± 7.1	2.9 ± 3.6	0.52

Deep small bowel refers to jejunum and ileum. The following statistical tests were utilized: paired t test (days to first endoscopic study), Wilcoxon rank-sum test (age, hemoglobin), and Fisher’s exact test (change in anticoagulation, overt bleed, culprit lesion, culprit lesion location, endoscopic intervention performed). GIB: Gastrointestinal bleeding; IQR: Interquartile range; SD: Standard deviation.

Table 4 Outcomes for gastrointestinal bleeding encounters with endoscopic intervention vs none gastrointestinal bleeding

Factor	Endoscopic intervention	No endoscopic intervention	P value
Median number of days to subsequent GIB (IQR)	113 (15-302)	72 (24-178)	0.51
	n = 44	n = 97
Proportion with subsequent GIB within 30 days	29.5%	34.0%	0.37
	n = 44	n = 97
Median length of stay in days for those with GIB on admission (IQR)	12 (10-23)	12 (8-21)	0.58
	n = 31	n = 86

The following statistical tests were utilized: Wilcoxon rank-sum test [days to subsequent gastrointestinal bleeding (GIB), length of stay], and Fisher’s exact test (proportion with subsequent GIB within 30 d). GIB: Gastrointestinal bleeding; IQR: Interquartile range.