Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website https://www.gastrores.org

Original Article

Volume 17, Number 1, February 2024, pages 1-9

Pre- and Post-Implant Endoscopy in Left Ventricular Assist Device Recipients: A Single-Center Experience

Figures

Figure 1.
Figure 1. Comparison of the incidence of gastrointestinal bleeding (GIB) between patients who underwent pre-left ventricular assist device (LVAD) endoscopic evaluation and those who did not.
Figure 2.
Figure 2. Incidence of GIB in those who did undergo pre-LVAD endoscopic evaluation compared to those who did not. GIB: gastrointestinal bleeding; LVAD: left ventricular assist device.
Figure 3.
Figure 3. Diagnostic yield of endoscopy in identifying source of bleeding within 1 year post-LVAD placement. LVAD: left ventricular assist device.
Figure 4.
Figure 4. Therapeutic yield of endoscopy within 1year post-LVAD placement. LVAD: left ventricular assist device; APC: argon plasma coagulation.

Tables

Table 1. Demographics and Patient Characteristics of Study Population
 
VariableCohort (n = 167)
GIB: gastrointestinal bleeding; LVAD: left ventricular assist device.
Age at LVAD implantation, years, mean (IQR 25-75%)61.5 (17 - 79)
Gender
  Male130 (77.8%)
  Female37 (22.2%)
Race
  White152 (91%)
  Black14 (8.4%)
  Hispanic1 (0.6%)
Type of LVAD
  HeartWare38 (22.8%)
  HeartMate 297 (58%)
  HeartMate 326 (15.6%)
  PVAD6 (3.6%)
Indication for LVAD implantation
  Ischemic cardiomyopathy91 (55.5%)
  Non-ischemic cardiomyopathy76 (44.5%)
Previous history of GIB before LVAD implantation
  No134 (80.2)
  Yes33 (19.8)
GIB within 1 year after LVAD
  No111 (66.5)
  Yes56 (33.5)
Antiplatelets within 1 year after LVAD
  None3
  Single agent (aspirin)34
  Dual agents (aspirin + clopidogrel)1
  N/A18
Number of hospital admission for GIB within 1 year after LVAD
  125
  213
  30
  41
  51
Indication for hospital admission for GIB within 1 year after LVAD
  Melena32 (80)
  Hematochezia5 (12.5)
  Combined melena and hematochezia2 (5)
  Hematemesis and melena1 (2.5)

 

Table 2. Comparison of Endoscopic Modality and Findings in Two Groups
 
Pre-LVAD (n = 23)Post-LVAD (n = 55)
EGD: esophagogastroduodenoscopy; LVAD: left ventricular assist device.
Scope modality
  EGD14 (60.9%)37 (67.3%)
  Colonoscopy9 (39.1%)27 (49.1%)
  Enteroscopy3 (13.0%)20 (36.4%)
  Capsule1 (4.3%)4 (7.27%)
Source of bleeding
  Peptic ulcer disease7 (30.4%)19 (34.6%)
  Angiodysplasia2 (8.70%)26 (47.3%)
  Polyps3 (13.0%)14 (25.5%)
  Hemorrhoids3 (13.0%)7 (12.7%)
  Diverticulosis5 (21.7%)14 (25.5%)
  Esophageal disease2 (8.7%)2 (3.64%)
  Duodenal disease4 (17.4%)2 (3.64%)
  Ischemic colitis0 (0.0%)2 (3.64%)
Location of lesion
  No source identified5 (21.7%)9 (16.3%)
  Stomach3 (13.0%)27 (49.1%)
  Small intestine3 (13.0%)25 (45.5%)
  Large intestine3 (13.0%)30 (54.5%)
  Ano-rectal3 (13.0%)8 (14.5%)

 

Table 3. Incidence of GIB in Those With Pre-LVAD Endoscopic Evaluation Compared to Those Without Endoscopic Evaluation
 
GIBNo GIBP value
GIB: gastrointestinal bleeding; LVAD: left ventricular assist device.
No pre-LVAD endoscopy (n = 144)32.6% (n = 47)67.3% (n = 97)
Pre-LVAD endoscopy (n = 23)39.1% (n = 9)60.9% (n = 14)0.6

 

Table 4. Odds Ratio (OR) for Post-LVAD Endoscopic Findings Compared to Pre-LVAD Findings
 
Endoscopic findingsOR95% CI
LVAD: left ventricular assist device; CI: confidence interval.
Peptic ulcer disease1.210.42 - 3.44
Angiodysplasia9.412.01 - 44.09
Polyps2.280.59 - 8.84
Hemorrhoids0.970.23 - 4.14
Diverticulosis1.230.38 - 3.93