University of Missouri Kansas City School of Medicine Kansas City, MO
Introduction: Gastrointestinal bleeding (GIB) is a frequent complication in patients with a left ventricular assist device (LVAD). Small bowel angiodysplasias are the most common source of bleeding. The optimal approach to pre-screen patients before LVAD implantation remains unclear. The aim of this study is to describe pre-and-post-LVAD endoscopy findings.
Methods: A retrospective review was conducted among all patients who underwent LVAD implantation, at Saint Luke’s Hospital between 2010 and 2020. Data were reviewed to determine the yield and safety of endoscopic procedures performed within 1 month before LVAD placement and the incidence of GIB within 1 year after implantation.
Results: Among 205 patients who received an LVAD, 167 met the inclusion criteria for this study and 23 underwent pre-implantation endoscopic evaluation. Modalities of pre-LVAD endoscopy included EGD 14/23 (60.9%), colonoscopy 9/23 (39.1%), enteroscopy 3/23 (13%), and capsule endoscopy 1/23 (4.3%), with the most frequently identified source of peptic disease. Of 56 patients who experienced post-LVAD bleeding, 55 underwent endoscopy where angiodysplasia was the most frequently identified source, though peptic disease, polyps, and diverticular bleeds were also common. Therapeutic interventions were successful in attaining hemostasis in almost all cases without adverse events. There was no difference in the rates of GI bleeding in patients who underwent endoscopic evaluation pre-LVAD (39.1% vs 32.6%, p=0.64).
Discussion: GIB is a common event following LVAD placement. Pre-LVAD endoscopic evaluation done within 1 month prior to implantation does not reduce the incidence of post-LVAD bleeding, and its role remains questionable.
