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 http://www.gastrores.org

Original Article

Volume 10, Number 5, October 2017, pages 280-287


Efficacy of Video Capsule Endoscopy in the Management of Suspected Small Bowel Bleeding in Patients With Continuous Flow Left Ventricular Assist Devices

Figures

Figure 1.
Figure 1. Flow chart for inclusion in the study and subsequent management of CF-LVAD patients with suspected small bowel bleed.
Figure 2.
Figure 2. Kaplan-Meier plot showing time to re-bleed or related death. Panel a shows the cumulative failure function for our primary endpoint with all patient encounters included. Panel b shows the same data but after removal of patients in the control group who did not get VCE due to death or critical illness. Data were censored at the time of transplant, death unrelated to GI bleeding, or last contact in the chart, and is indicated by a vertical dash in the figure. P values displayed are calculated by the log-rank test.

Tables

Table 1. Baseline Characteristics of VCE and non-VCE Encounters
 
Capsule (n = 15)No capsule (n = 25)P value
VAD: ventricular assist device; COPD: chronic obstructive pulmonary disease; GI: gastrointestinal; ASA: American Society of Anesthesiology; RBC: red blood cell; INR: international normalized ratio; EGD: esophagogastroduodenoscopy.
Demographics
  Age (mean)63.1 (57.0 - 69.3)63.7 (59.1 - 68.3)0.884
  Sex (% male)93.3 (68.1 - 99.8)68.0 (46.5 - 85.1)0.117
  Ethnicity (% White/Black/Hispanic/Asian)46.6/33.3/6.7/13.344.0/36.0/20.0/00.224
Co-morbidities
  VAD as destination therapy (%)66.7 (38.4 - 88.2)48.0 (27.8 - 68.7)0.332
  Ischemic cardiomyopathy (%)53.3 (26.6 - 78.7)72.0 (50.6 - 87.9)0.310
  Diabetes (%)53.3 (26.9 - 78.7)36.0 (18.0 - 57.5)0.336
  COPD or asthma (%)40.0 (16.3 - 67.7)24.0 (9.4 - 45.1)0.311
  Prior GI bleed (%)40.0 (16.3 - 67.7)48.0 (28.0 - 68.7)0.747
  ASA status (mean)3.33 (2.88 - 3.79)3.20 (2.96 - 3.44)0.549
Clinical presentation
  Melena (%)60.0 (32.3 - 83.7)84.0 (63.9 - 95.5)0.135
  Hematochezia (%)33.3 (11.8 - 61.6)16.0 (4.5 - 36.1)0.225
  Hematemesis (%)0 (0 - 21.8)12.0 (2.5 - 31.2)0.279
  Occult bleed (%)20.0 (4.3 - 48.1)8.0 (0.1 - 26.0)0.345
Anticoagulation
  Aspirin (%)73.3 (44.9 - 92.2)96.1 (79.6 - 99.9)0.056
  Warfarin (%)80.0 (51.9 - 95.7)80.0 (59.3 - 93.2)1.000
  Heparin (%)13.3 (1.7 - 40.5)16.0 (4.5 - 36.1)1.000
  Argatroban (%)0 (0 - 21.8)4.0 (0.1 - 20.4)1.000
  Plavix (%)0 (0 - 21.8)4.0 (0.1 - 20.4)1.000
  Eptifatide (%)0 (0 . 21.8)0 (0 - 13.7)1.000
Laboratory values
  RBC transfusion (median units 72 h prior to scope)3 (0 - 4)2 (1 - 3)0.591
  Platelet transfusion (median units 72 h prior to scope)0 (0 - 0)0 (0 - 0)0.267
  FFP transfusion (median units 72 h prior to scope)0 (0 - 0)0 (0 - 1)0.276
  Hemoglobin (mean)7.97 (7.38 - 8.56)8.55 (8.05 - 9.04)0.135
  Platelets (mean)245 (198 - 290)188 (154 - 222)0.041
  Creatinine (mean)1.25 (1.19 - 1.62)1.40 (1.19 - 1.62)0.421
  Dialysis (%)0 (0 - 21.8)12.0 (2.5 - 31.2)0.279
  INR (mean)1.83 (1.52 - 2.14)2.06 (1.79 - 2.32)0.269
Vital signs before endoscopy
  Intubated prior (%), not including for procedure0 (0 - 21.8)24.0 (9.4 - 45.1)0.067
  Inspired O2 (median %)21.0 (21.0 - 21.0)21.0 (21.0 - 40.0)0.378
  Vasopressors (median)0 (0 - 0)0 (0 - 0)0.140
Initial workup
  EGD and Colonoscopy (%)86.6 (59.5 - 98.3)36.0 (18.0 - 57.5)0.003
  EGD only (%)13.3 (1.7 - 40.5)64.0 (42.5 - 82.0)0.003

 

Table 2. Endoscopic Findings and Management of VCE and Non-VCE Encounters
 
Capsule (n = 15)No capsule (n = 25)P value
AVM: arteriovenous malformation; GAVE: gastric antral vascular ectasia; APC: argon plasma coagulation; IR: interventional radiology; RBC: red blood cell.
Findings
  AVM (%)46.7 (21.3 - 73.4)32.0 (14.9 - 53.5)0.502
  Ulcer or erosion (%)33.3 (11.8 - 61.6)20.0 (6.8 - 40.7)0.457
  Gastritis (%)13.3 (1.7 - 40.5)12.0 (2.5 - 31.2)1.000
  Polyp (%)40.0 (16.3 - 67.7)8.0 (0.9 - 26.0)0.036
  GAVE (%)13.3 (1.7 - 40.5)4.0 (0.1 - 20.4)0.545
Endoscopic intervention
  APC (%)40.0 (16.3 - 67.7)24.0 (9.4 - 45.1)0.311
  Clip (%)13.3 (1.7 - 40.5)12.0 (2.5 - 31.2)1.000
  Injection (%)0 (0 - 21.8)0 (0 - 13.7)1.000
  Snare (%)6.7 (0.1 - 31.9)0 (0 - 13.7)0.375
Management
  IR intervention (%)6.7 (0.2 - 31.9)0 (0 - 13.7)0.375
  Tagged RBC scan (%)0 (0 - 21.8)8.0 (0.9 - 26.0)0.519
  Start octreotide or thalidomide (%)46.7 (21.3 - 73.4)52.0 (31.3- 72.2)1.000
  Double balloon enteroscopy (%)20.0 (4.3 - 48.1)12.0 (2.5 - 31.2)0.654
  Push enteroscopy (%)6.7 (0.2 - 31.9)12.0 (2.5 - 31.2)1.000
  Any enteroscopy (%)26.7 (7.8 - 55.1)20.0 (6.8 - 40.7)0.705

 

Table 3. Thirty Day Outcomes for VCE and Non-VCE Encounters
 
Events within 30 daysCapsule (n = 15)No capsule (n = 25)P value
PRBC: packed red blood cell: GI: gastrointestinal.
Readmission (%)46.7 (21.3 - 73.4)16.0 (4.5 - 36.1)0.065
Related readmission (%)20.0 (4.3 - 48.1)8.0 (1.0 - 26.0)0.345
Length of stay (median days)12 (5 - 30)6 (3 - 15)0.117
Any adverse event (%)6.7 (0.2 - 31.9)36.0 (18.0 - 57.5)0.060
Any adverse event or re-bleeding (%)33.3 (11.8 - 61.6)56.0 (34.9 - 75.6)0.204
PRBC transfusion (median units)3 (0 - 7)1 (0 - 10)0.864
Death (%)0 (0 - 21.8)20.0 (6.8 - 40.7)0.137
Death related to GI bleed (%)0 (0 - 21.8)12.0 (2.5 - 31.2)0.279