CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(08): E1002-E1008
DOI: 10.1055/a-1181-8340
Original article

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

Badar M. Hasan
1   Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, United States
,
Charles McMahon
2   Department of Internal Medicine, Division of Gastroenterology, Loyola University Medical Center, Chicago, Illinois, United States
,
Rumman A. Khalid
1   Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, United States
,
Yasar Colak
1   Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, United States
,
Daniel C. Mayorga
1   Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, United States
,
Ahmed Elkafrawy
4   Department of Gastroenterology and Hepatology, Saint Lukeʼs Hospital of Kansas City/University of Missouri Kansas City (UMKC), Missouri, United States
,
Kanwarpreet Tandon
1   Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, United States
,
Muhammad Shafiq
3   Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, United States
,
Ishtiaq Hussain
1   Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, United States
,
Tolga Erim
1   Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, United States
,
Fernando Castro
1   Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, United States
,
Roger Charles
1   Department of Gastroenterology, Cleveland Clinic Florida, Weston, Florida, United States
,
Rajiv Chhabra
4   Department of Gastroenterology and Hepatology, Saint Lukeʼs Hospital of Kansas City/University of Missouri Kansas City (UMKC), Missouri, United States
› Author Affiliations

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.



Publication History

Received: 17 December 2019

Accepted: 16 April 2020

Article published online:
21 July 2020

© 2020. Owner and Copyright ©

© Georg Thieme Verlag KG
Stuttgart · New York

 
  • References

  • 1 Benjamin EJ, Blaha MJ, Chiuve SE. et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135: e146-e603
  • 2 Heidenreich PA, Albert NM, Allen LA. et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail 2013; 6: 606-619
  • 3 Islam S, Cevik C, Madonna R. et al. Left ventricular assist devices and gastrointestinal bleeding: a narrative review of case reports and case series. Clin Cardiol 2013; 36: 190-200
  • 4 Demirozu ZT, Radovancevic R, Hochman LF. et al. Arteriovenous malformation and gastrointestinal bleeding in patients with the HeartMate II left ventricular assist device. J Heart Lung Transplant 2011; 30: 849-853
  • 5 Decker GA, Miller ED, Pasha SF. et al. Deep enteroscopy in patients with left ventricular assist devices: practical and technical considerations. Endoscopy 2010; 42 (Suppl. 02) E194
  • 6 Kwong WT, Pearlman M, Kalmaz D. Safety of Deep enteroscopy and capsule endoscopy in lvad patients: case report and literature review. Gastroenterology Res 2015; 8: 309-312
  • 7 Edwards AL, Monkemuller K, Pamboukian SV. et al. Utility of double-balloon enteroscopy in patients with left ventricular assist devices and obscure overt gastrointestinal bleeding. Endoscopy 2014; 46: 986-991
  • 8 Benmassaoud A, Sasson MS, Pamphile JC. et al. The use of balloon-assisted enteroscopy at a large volume centre: a retrospective analysis. J Can Assoc Gastroenterol 2018; 1: 33-39
  • 9 Rose EA, Gelijns AC, Moskowitz AJ. et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med 2001; 345: 1435-1443
  • 10 Koul A, Pham DM, Nanda A. et al. Safety and efficacy of single-balloon enteroscopy in management of gastrointestinal bleeding in patients with a left ventricular assist device. Endosc Int Open 2017; 5: E179-E183
  • 11 Daas AY, Small MB, Pinkas H. et al. Safety of conventional and wireless capsule endoscopy in patients supported with nonpulsatile axial flow Heart-Mate II left ventricular assist device. Gastrointest Endosc 2008; 68: 379-382
  • 12 Shrode CW, Draper KV, Huang RJ. et al. Significantly higher rates of gastrointestinal bleeding and thromboembolic events with left ventricular assist devices. Clin Gastroenterol Hepatol 2014; 12: 1461-1467
  • 13 Morgan JA, Paone G, Nemeh HW. et al. Gastrointestinal bleeding with the HeartMate II left ventricular assist device. J Heart Lung Transplant 2012; 31: 715-718
  • 14 Stern DR, Kazam J, Edwards P. et al. Increased incidence of gastrointestinal bleeding following implantation of the HeartMate II LVAD. J Card Surg 2010; 25: 352-356
  • 15 Stern DR, Kazam J, Shariff S. et al. 60: Increased incidence of gastrointestinal bleeding following implantation of Heartmate II LVAD. J Heart Lung Transplant 2009; 28: S86
  • 16 Sarosiek K, Bogar L, Conn MI. et al. An old problem with a new therapy: gastrointestinal bleeding in ventricular assist device patients and deep overtube-assisted enteroscopy. ASAIO J 2013; 59: 384-389
  • 17 Tarzia V, Dal Lin C, Bottio T. et al. Occult gastrointestinal bleeding in patients with a left ventricular assist device axial flow pump: diagnostic tools and therapeutic algorithm. J Thorac Cardiovasc Surg 2012; 143: e28-31
  • 18 Harris LA, Hansel SL, Rajan E. et al. Capsule endoscopy in patients with implantable electromedical devices is safe. Gastroenterol Res Pract 2013; 2013: 959234
  • 19 Girelli CM, Tartara P, Vitali E. Lack of reciprocal interference between capsule endoscope and left ventricular assist device. Endoscopy 2006; 38: 94-95; discussion 95
  • 20 Fenkel JM, Grasso MA, Goldberg EM. et al. Capsule endoscopy is safe in patients with pulsatile Novacor PC left ventricular assist device. Gastrointest Endosc 2007; 65: 559-560; author reply 560
  • 21 Bechtel JF, Wellhoner P, Charitos EI. et al. Localizing an occult gastrointestinal bleeding by wireless PillCam SB capsule videoendoscopy in a patient with the HeartMate II left ventricular assist device. J Thorac Cardiovasc Surg 2010; 139: e73-74
  • 22 Yamamoto H, Sekine Y, Sato Y. et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 2001; 53: 216-220
  • 23 Mensink PB, Haringsma J, Kucharzik T. et al. Complications of double balloon enteroscopy: a multicenter survey. Endoscopy 2007; 39: 613-615
  • 24 Gerson LB, Tokar J, Chiorean M. et al. Complications associated with double balloon enteroscopy at nine US centers. Clin Gastroenterol Hepatol 2009; 7: 1177-1182 , 1182 e1171–1173
  • 25 Luc JGY, Tchantchaleishvili V, Phan K. et al. Medical Therapy as compared to surgical device exchange for left ventricular assist device thrombosis: a systematic review and meta-analysis. ASAIO J 2019; 65: 307-317
  • 26 Gurvits GE, Fradkov E. Bleeding with the artificial heart: Gastrointestinal hemorrhage in CF-LVAD patients. World J Gastroenterol 2017; 23: 3945-3953
  • 27 Al-Bawardy B, Piovezani RamosG, Lennon RJ. et al. Outcomes of repeat balloon assisted enteroscopy in small-bowel bleeding. Endosc Int Open 2018; 6: E694-E699
  • 28 Akarsu M, Akkaya Ozdinc S, Celtik A. et al. Diagnostic and therapeutic efficacy of double-balloon endoscopy in patients with small intestinal diseases: single-center experience in 513 procedures. Turk J Gastroenterol 2014; 25: 374-380
  • 29 Shinozaki S, Yamamoto H, Yano T. et al. Long-term outcome of patients with obscure gastrointestinal bleeding investigated by double-balloon endoscopy. Clin Gastroenterol Hepatol 2010; 8: 151-158
  • 30 Yano T, Yamamoto H, Sunada K. et al. Endoscopic classification of vascular lesions of the small intestine (with videos). Gastrointest Endosc 2008; 67: 169-172