Published online Jul 7, 2021. doi: 10.3748/wjg.v27.i25.3877
Peer-review started: February 14, 2021
First decision: March 14, 2021
Revised: April 19, 2021
Accepted: June 2, 2021
Article in press: June 2, 2021
Published online: July 7, 2021
Patients with left ventricular assist devices (LVADs) are at increased risk for recurrent gastrointestinal bleeding (GIB) and repeat endoscopic procedures.
There are limited data on whether endoscopic intervention reduces recurrent bleeding, bringing into question its utility in managing this chronic issue.
Our primary aim was to evaluate for an association between endoscopic intervention and subsequent GIB. Secondary aims were to assess the frequency of GIB in our cohort, describe GIB presentations and sources identified, and determine risk factors for recurrent GIB.
We conducted a retrospective cohort study of all patients at a large academic institution who underwent LVAD implantation from January 2011 – December 2018 and assessed all hospital encounters for GIB through December 2019. We performed a descriptive analysis of the GIB burden and the outcome of endoscopic procedures performed. We performed multivariate logistic regression to evaluate the association between endoscopic intervention and subsequent GIB.
In the cohort of 295 patients, 97 (32.9%) had at least one GIB hospital encounter and recurrent GIB occurred in 55.5% (54/97) of patients. There were 238 hospital encounters, and GIB resolved on its own by discharge in 69.8% encounters. Of the 85.7% (204/238) of encounters that included at least one endoscopic evaluation, an endoscopic intervention was performed in 34.8% (71/204). The adjusted odds ratio for subsequent GIB if an endoscopic intervention was performed during a GIB encounter was not significant (odds ratio 1.18, P = 0.58).
In this retrospective cohort study, adherence to endoscopic guidelines for performing endoscopic interventions did not significantly decrease the odds of subsequent GIB, thus suggesting the uniqueness of the LVAD population.
A prospective study is needed to identify patients with LVAD at risk of recurrent GIB and determine more effective management strategies.