Dakik Hassan K, McGhan Alyson A, Chiu Shih-Ting, Patel Chetan B, Milano Carmelo A, Rogers Joseph G, Chow Shein-Chung, Wild Daniel M
Division of Gastroenterology, Duke University Hospital, Box 3913, Durham, NC, 27701, USA.
Division of Biostatistics, Duke University Hospital, Durham, NC, USA.
Dig Dis Sci. 2016 Jun;61(6):1603-10. doi: 10.1007/s10620-015-4028-7. Epub 2016 Jan 25.
Left ventricular assist devices (LVADs) are increasingly common in patients with advanced heart failure. GI bleeding (GIB) occurs in 20-30 % of these patients and can arise anywhere in the GI tract. Given the high rates of GIB in this population, our aim was to determine the diagnostic yield of repeated endoscopic evaluation in these patients.
We performed a retrospective review of all 257 patients who had LVADs placed between 2008 and 2013 at Duke University Hospital and identified all patients who underwent any endoscopic evaluation for GIB.
Of the 257 patients with LVADs placed, 78 (30 %) underwent at least one endoscopy for GIB. A source was identified in 36 % of cases, most commonly angioectasias (53.6 %). Treatment was performed in 67.9 % of patients and hemostasis was achieved in all. 64.1 % of the cohort underwent a second endoscopy for GIB. 42.9 % of these exams revealed a bleeding source. Endoscopic treatment was employed in 76.2 %. 38.5 % of the cohort underwent a third endoscopic exam for bleeding and a source was identified in 53.3 % with angioectasias remaining most common (56.3 %). By Fisher's exact and Chi-square testing, only the presence of a bleeding source (p = 0.0034) and use of hemostatic therapy (p = 0.0127) on the index examination were significantly associated with re-bleeding.
GIB is common in patients with LVADs. The diagnostic and therapeutic yield of endoscopy is remains high with repeated interventions. Despite these high yields, a large portion of the cohort requires repeated interventions for recurrent bleeding.
左心室辅助装置（LVAD）在晚期心力衰竭患者中越来越常见。20%-30%的此类患者会发生胃肠道出血（GIB），且可发生于胃肠道的任何部位。鉴于该人群中GIB的发生率较高，我们的目的是确定对这些患者进行重复内镜评估的诊断率。
我们对2008年至2013年在杜克大学医院植入LVAD的所有257例患者进行了回顾性研究，并确定了所有接受过GIB内镜评估的患者。
在257例植入LVAD的患者中，78例（30%）因GIB至少接受了一次内镜检查。36%的病例找到了出血源，最常见的是血管扩张（53.6%）。67.9%的患者接受了治疗，所有患者均实现止血。64.1%的队列因GIB接受了第二次内镜检查。其中42.9%的检查发现了出血源。76.2%的患者采用了内镜治疗。38.5%的队列因出血接受了第三次内镜检查，53.3%的患者找到了出血源，血管扩张仍是最常见的（56.3%）。通过Fisher精确检验和卡方检验，仅首次检查时存在出血源（p = 0.0034）和使用止血治疗（p = 0.0127）与再出血显著相关。
GIB在LVAD患者中很常见。重复干预时，内镜检查的诊断和治疗率仍然很高。尽管有这些高成功率，但很大一部分队列需要因复发性出血进行重复干预。
