Truss Wiley D, Weber Frederick, Pamboukian Salpy V, Tripathi Arvind, Peter Shajan
From the *Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; †Division of Cardiology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and ‡School of Public Health, Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama.
ASAIO J. 2016 Jan-Feb;62(1):40-5. doi: 10.1097/MAT.0000000000000303.
Gastrointestinal bleeding (GIB) is a frequent challenge encountered in patients implanted with a left ventricular assist device (LVAD), affecting approximately 25% of this population. Many patients have no identifiable source of bleeding after routine esophagogastroduodenoscopy and colonoscopy and are labeled as obscure GIB (OGIB). Significant costs and invasive procedures are required to investigate and stop the source of bleeding in these patients. We performed a retrospective analysis at a single tertiary referral center to investigate the diagnostic yield and overall effectiveness of video capsule enteroscopy (VCE) in this population. Eight patients with LVADs underwent nine VCE studies for OGIB. The diagnostic yield was 100%, with intraluminal blood the most common finding. The jejunum was the most common location for pathology detected on VCE. Sixty-seven percent of the studies directly guided further endoscopy with successful cessation of bleeding in 100% of these patients. Finally, after an average follow-up of 46 weeks, the total number of endoscopic procedures and total units of transfused packed red blood cells (pRBC) were significantly less after the patient underwent the VCE study compared with before. Video capsule enteroscopy is a safe and high-yield investigative procedure in this population and should be implemented earlier to improve patient outcomes and reduce costs of care.
胃肠道出血（GIB）是植入左心室辅助装置（LVAD）的患者经常面临的挑战，约25%的此类患者会受到影响。许多患者在进行常规食管胃十二指肠镜检查和结肠镜检查后无法确定出血源，被归类为不明原因胃肠道出血（OGIB）。调查并止住这些患者的出血源需要高昂的费用和侵入性操作。我们在一家单一的三级转诊中心进行了一项回顾性分析，以研究视频胶囊内镜检查（VCE）在该人群中的诊断率和总体有效性。8名植入LVAD的患者因OGIB接受了9次VCE检查。诊断率为100%，腔内血液是最常见的发现。空肠是VCE检测到病变的最常见部位。67%的检查直接指导了进一步的内镜检查，这些患者中有100%成功止血。最后，在平均随访46周后，与VCE检查前相比，患者接受VCE检查后内镜检查的总数和输注的红细胞（pRBC）总量明显减少。视频胶囊内镜检查在该人群中是一种安全且高诊断率的检查方法，应尽早实施以改善患者预后并降低护理成本。
