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DOI: 10.1055/s-0038-1637486
DOUBLE-BALLOON ENTEROSCOPY IN PATIENTS WITH LEFT VENTRICULAR ASSIST DEVICE (LVAD)
Publication History
Publication Date:
27 March 2018 (online)
Aims:
Patients with left ventricular assist device (LVAD) have an increased risk of gastrointestinal bleeding, mainly from angiodysplasia. In these patients, evaluation of the small bowel appears important for identification of bleeding and therapeutic management. However, data about deep enteroscopy in LVAD patients are limited. The aim of this study was to evaluate the safety and efficacy of double-balloon enteroscopy (DBE) in patients with LVAD.
Methods:
This study included patients who received a LVAD (Jarvik ®) at a tertiary medical center from 2015 to October 2017. Of these, we prospectively enrolled patients with anemia secondary to obscure gastrointestinal bleeding (OGIB). All patients underwent video capsule enteroscopy (VCE). Patients with evidence of small bowel bleeding underwent DBE.
Results:
A total of 11 patients underwent LVAD implantation from 2015 to October 2017. Of them, four patients (36%) were referred to our center for OGIB (mean age 68 yr). Mean time from LVAD positioning and GI bleeding was 7.2 ± 5.3 months. 2 patients underwent anterograde DBE for small bowel bleeding. In the first patient enteroscopy identified a jejunal oozing bleeding treated with 2 clips. In the second patient DBE was performed 3 times: the first time with no evidence of bleeding; the second time (after 2 months) with evidence of jejunal bleeding from visible vessel, treated with argon plasma coagulation (APC) and 2 clips; the third time (after 7 months) for rebleeding, treated again with APC and 3 clips. A total of 4 anterograde DBE were performed. Mean insertion depth was 300 cm. All procedures were well tolerated with standard sedation (Midazolam + Meperidine). No adverse events related to procedures were recorded.
Conclusions:
Double-balloon enteroscopy is safe and effective in patients with LVAD