Patel Brijesh, Shiani Ashok, Rodriguez Andrea C, Lipka Seth, Davis-Yadley Ashley H, Nelson Kirbylee K, Rabbanifard Roshanak, Kumar Ambuj, Brady Patrick G
From the Departments of Digestive Diseases and Nutrition, Internal Medicine, and Evidence-Based Medicine and Research Outcomes, University of South Florida, Tampa.
South Med J. 2019 Feb;112(2):130-134. doi: 10.14423/SMJ.0000000000000938.
Obscure overt gastrointestinal bleeding can be challenging to evaluate in patients with electronic cardiac devices such as continuous flow left ventricular assist devices (LVADs), pacemakers (PPMs), and implantable cardioverter defibrillators (ICDs). Limited data exist on the utility and safety of single balloon enteroscopy (SBE) in patients with cardiac devices. We aimed to evaluate the safety, efficacy, diagnostic, and therapeutic outcomes of the aforementioned devices in patients undergoing SBE.
A retrospective study was performed using the medical records of 57 patients undergoing SBE at our institution from 2010 to 2014. Patients were divided into two groups: those with cardiac devices and those without. Data on comorbidities, complications, findings, diagnostic, and therapeutic yield were compared. Test and logistic regression assessed the association between dependent and independent variables. For continuous data, the results were summarized as mean difference and standard deviation. For dichotomous data, the results were summarized as odds ratio and 95% confidence intervals.
The overall age in patients with cardiac devices was 67.89 ± 6.96 versus 66.03 ± 11.95 years in the control. The cardiac device group was composed of 42.1% women; the control comprised 21.1% women. There were 19 patients with cardiac devices; 8 (LVAD + ICD), 1 (LVAD + PPM + ICD), 2 (PPM + ICD), 6 (PPM), 2 (ICD); 38 patients were in the control group. Patients with cardiac devices were hospitalized more often than patients without devices; this finding was not statistically significant (odds ratio 1.826, 95% confidence interval 0.544-6.128, = 0.389). Procedure times were longer in the cardiac device group, 65.16 ± 49.92 minutes, when compared with the control, 57.40 ± 20.42, but it also did not reach statistical significance (mean difference 7.758, 95% confidence interval -11.360 to 26.876, = 0.049). There was no statistically significant difference in major or minor events between patients with cardiac devices and the control group. Diagnostic and therapeutic yield and rebleeding rates were similar across both groups.
Patients in the cardiac device group did not appear to be at any more significant risk than those without cardiac devices. Furthermore, diagnostic and therapeutic yield and rebleeding rates appear to be similar across both groups. Clinicians may perform SBE in these patients safely and effectively, with good overall outcomes.
对于使用连续性血流左心室辅助装置（LVAD）、起搏器（PPM）和植入式心脏复律除颤器（ICD）等电子心脏装置的患者，隐匿性显性胃肠道出血的评估具有挑战性。关于单气囊小肠镜检查（SBE）在心脏装置患者中的效用和安全性的数据有限。我们旨在评估上述装置在接受SBE的患者中的安全性、有效性、诊断及治疗结果。
采用回顾性研究，分析了2010年至2014年在我院接受SBE的57例患者的病历。患者分为两组：有心脏装置的患者和无心脏装置的患者。比较了合并症、并发症、检查结果、诊断及治疗的有效率等数据。采用检验和逻辑回归评估因变量和自变量之间的关联。对于连续性数据，结果以平均差和标准差表示。对于二分数据，结果以比值比和95%置信区间表示。
有心脏装置患者的总体年龄为67.89±6.96岁，而对照组为66.03±11.95岁。心脏装置组女性占42.1%；对照组女性占21.1%。有19例患者装有心脏装置；8例（LVAD + ICD），1例（LVAD + PPM + ICD），2例（PPM + ICD），6例（PPM），2例（ICD）；38例患者在对照组。装有心脏装置的患者比未装装置的患者住院更频繁；这一发现无统计学意义（比值比1.826，95%置信区间0.544 - 6.128，P = 0.389）。心脏装置组的操作时间更长，为65.16±49.92分钟，而对照组为57.40±20.42分钟，但也未达到统计学意义（平均差7.758，95%置信区间 - 11.360至26.876，P = 0.049）。装有心脏装置的患者与对照组之间在主要或次要事件上无统计学显著差异。两组的诊断及治疗有效率和再出血率相似。
心脏装置组患者似乎并不比无心脏装置的患者面临更大的风险。此外，两组的诊断及治疗有效率和再出血率似乎相似。临床医生可以安全有效地对这些患者进行SBE，总体结果良好。
