Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA 19104, United States.
Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States.
World J Gastroenterol. 2021 Jul 7;27(25):3877-3887. doi: 10.3748/wjg.v27.i25.3877.
Patients with left ventricular assist devices (LVADs) are at increased risk for recurrent gastrointestinal bleeding (GIB) and repeat endoscopic procedures. We assessed the frequency of endoscopy for GIB in patients with LVADs and the impact of endoscopic intervention on preventing a subsequent GIB.
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. There were 238 hospital encounters, with 55.4% (132/238) within the first year of LVAD implantation. GIB resolved on its own by discharge in 69.8% (164/235) encounters. Recurrent GIB occurred in 55.5% (54/97) of patients, accounting for 59.2% (141/238) of all 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, = 0.58).
Patients implanted with LVADs whom experience recurrent GIB frequently undergo repeat admissions and endoscopic procedures. 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.
植入左心室辅助装置(LVAD)的患者发生复发性胃肠道出血(GIB)和重复内镜检查的风险增加。我们评估了 LVAD 患者因 GIB 进行内镜检查的频率以及内镜干预对预防随后发生 GIB 的影响。
评估内镜干预与随后发生 GIB 之间的关系。次要目的是评估我们队列中 GIB 的频率,描述 GIB 的表现和确定的来源,并确定复发性 GIB 的危险因素。
我们对 2011 年 1 月至 2018 年 12 月在一家大型学术机构植入 LVAD 的所有患者进行了回顾性队列研究,并通过 2019 年 12 月评估了所有因 GIB 而就诊的患者。我们对 GIB 负担和内镜治疗结果进行了描述性分析。我们进行了多变量逻辑回归分析,以评估内镜干预与随后发生 GIB 之间的关系。
在 295 例患者中,有 97 例(32.9%)至少有一次 GIB 就诊。共发生 238 次就诊,其中 55.4%(132/238)发生在 LVAD 植入后的第一年。69.8%(164/235)的就诊患者在出院时 GIB 自行缓解。55.5%(54/97)的患者发生复发性 GIB,占所有就诊患者的 59.2%(141/238)。在至少进行了一次内镜评估的 85.7%(204/238)就诊中,有 34.8%(71/204)进行了内镜干预。如果在 GIB 就诊时进行内镜干预,随后发生 GIB 的调整比值比无统计学意义(比值比 1.18, = 0.58)。
经历复发性 GIB 的植入 LVAD 的患者经常需要再次入院和进行内镜检查。在这项回顾性队列研究中,内镜干预的内镜指南的遵守情况并未显著降低随后发生 GIB 的几率,这表明 LVAD 人群的独特性。需要进行前瞻性研究以确定具有复发性 GIB 风险的 LVAD 患者,并确定更有效的管理策略。