Endoscopic Findings and Clinical Outcomes in Ventricular Assist Device Recipients with Gastrointestinal Bleeding

  • B. Joseph Elmunzer
  • Kunjali T. Padhya
  • Jason J. Lewis
  • Amol S. Rangnekar
  • Sameer D. Saini
  • Shanti L. Eswaran
  • James M. Scheiman
  • Francis D. Pagani
  • Jonathan W. Haft
  • Akbar K. Waljee
Original Article

Abstract

Background

Gastrointestinal bleeding (GIB) is an important clinical problem in recipients of ventricular assist devices (VAD), although data pertaining to the endoscopic evaluation and management of this complication are limited in the medical literature.

Aims

We sought to identify the most common endoscopic findings in VAD recipients with GIB, and to better define the diagnostic and therapeutic utility of endosopy for this patient population.

Methods

Twenty-six subjects with VAD and overt GIB were retrospectively identified. Clinical and endoscopic data were abstracted for each subject on to standardized forms in duplicate and independent fashion. Raw data and descriptive statistics were reported.

Results

Non-peptic vascular lesions were the most common cause of GIB. A definitive cause of bleeding was identified by endoscopy in almost 60% of subjects. Endoscopic hemostasis was achieved in 14/15 patients in whom bleeding did not stop spontaneously. Rebleeding occurred in 50% of subjects and was successfully retreated or stopped spontaneously in all cases. Colonoscopy did not establish a definitive diagnosis or deliver hemostatic therapy in any case.

Conclusions

Vascular malformations account for the overwhelming majority of bleeding lesions in VAD patients with GIB. Endoscopy seems to be a safe and effective tool for diagnosing, risk stratifying, and treating this patient population, although multiple endoscopies may be necessary before therapeutic success, and the incidence of rebleeding is high. A prospective multi-center registry is necessary to establish evidence-based management algorithms for VAD recipients with GIB.

Keywords

Ventricular assist device Gastrointestinal hemorrhage Endoscopic evaluation Endoscopic hemostasis 

Notes

Acknowledgment

Dr. Elmunzer’s and Dr. Waljee’s contributions to this study were supported by grant number UL1RR024986 from the National Center for Research Resources. The content is solely the responsibility of the authors and does not necessarily represent the official views of NCRRR or the National Institutes of Health.

Conflicts of interest

The authors have no conflicts if interest to disclose relating to this manuscript.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • B. Joseph Elmunzer
    • 1
  • Kunjali T. Padhya
    • 2
  • Jason J. Lewis
    • 1
  • Amol S. Rangnekar
    • 1
  • Sameer D. Saini
    • 1
  • Shanti L. Eswaran
    • 1
  • James M. Scheiman
    • 1
  • Francis D. Pagani
    • 3
  • Jonathan W. Haft
    • 3
  • Akbar K. Waljee
    • 1
  1. 1.Division of GastroenterologyUniversity of Michigan Medical CenterAnn ArborUSA
  2. 2.Department of Internal MedicineUniversity of Michigan Medical CenterAnn ArborUSA
  3. 3.Division of Cardiac SurgeryUniversity of Michigan Medical CenterAnn ArborUSA

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