Small bowel bleeding in patients with left ventricular assist device: outcomes of conservative therapy versus balloon‑assisted enteroscopy

Badr Al-Bawardy; Sarah D. Schettle; Emmanuel Gorospe; Louis M. Wong Kee Song; Naveen L. Pereira; Jeffrey A. Alexander; David H. Bruining; Nayantara Coelho-Prabhu; Jeff L. Fidler; William J. Mauermann; David W. Barbara; Ross Dierkhising; Elizabeth Rajan

Authors Badr Al-Bawardy, Sarah D. Schettle, Emmanuel Gorospe, Louis M. Wong Kee Song, Naveen L. Pereira, Jeffrey A. Alexander, David H. Bruining, Nayantara Coelho-Prabhu, Jeff L. Fidler, William J. Mauermann, David W. Barbara, Ross Dierkhising, Elizabeth Rajan.

Abstract

Background Small bowel bleeding (SBB) accounts for 30% of gastrointestinal bleeding (GIB) episodes in patients with a left ventricular assist device (LVAD). The aim of this study was to determine the outcomes of conservative therapy (CT) compared to balloon‑assisted enteroscopy (BAE) in the management of SBB in LVAD patients.

Methods A retrospective review was performed of a prospectively maintained LVAD database from January 2003 to July 2015. LVAD patients with SBB were classified into a BAE group or a CT group according to whether they did or did not undergo BAE.

Results Forty‑two patients (22 BAE, 20 CT) with mean age 66±9.3 years (79% male) were included. The yield of BAE was 64% without reported complications. Overt re‑bleeding occurred in 40% of the BAE group compared to 22% of the CT group. The BAE group had a higher mean number of GIB hospitalizations per month compared to the CT group (0.07 vs. 0.03; incidence rate ratio [IRR] 2.72, 95% CI 1.06‑6.98; P=0.04). There was no significant difference between the BAE and the CT groups in the number of packed red blood cell (pRBC) transfusions per
month (0.42 vs. 0.18; IRR 2.31, 95% CI 0.88‑6.04; P=0.09) or all‑cause mortality (61% in the CT group and 42% in the BAE group; P=0.90).

Conclusion BAE is safe in LVAD patients and has a moderate therapeutic yield. In our cohort of patients, BAE did not appear to improve re‑bleeding rate, GIB‑related hospitalizations, pRBC transfusions or mortality compared to CT. However, future prospective trials with larger sample sizes are needed to confirm these findings.

Keywords Small bowel bleeding, left ventricular assist device, capsule endoscopy, balloon‑assisted enteroscopy

Ann Gastroenterol 2018; 31 (6): 692-697