Mohamed Wael T, Jahagirdar Vinay, Jaber Fouad, Ahmed Mohamed K, Ghoz Hassan M, Sperry Brett W, Clarkston Wendell K
Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, USA.
Division of Gastroenterology, University of Missouri-Kansas City, Kansas City, MO, USA.
Gastroenterology Res. 2024 Feb;17(1):1-9. doi: 10.14740/gr1661. Epub 2024 Feb 28.
Gastrointestinal bleeding (GIB) is common in left ventricular assist devices (LVADs) patients, but the optimal screening approach before LVAD implantation is still unclear. The aim of the study was to describe our experience with pre- and post-LVAD implantation endoscopic screening and subsequent GI bleeding in this cohort.
A retrospective review was conducted among all patients who underwent LVAD implantation at Saint Luke's Hospital, between 2010 and 2020. The data were reviewed to determine the yield and safety of endoscopic procedures performed within 1 month before LVAD placement and the incidence of GIB within 1 year after implantation.
A total of 167 LVAD patients met the inclusion criteria, and 23 underwent pre-implantation endoscopic evaluation. Angiodysplasia had a significantly higher odds ratio (OR) of 9.41 (95% confidence interval (CI): 2.01 - 44.09) in post-LVAD endoscopy, while there was no significant difference in bleeding from other sources such as peptic ulcer disease or diverticular bleeding. There was no difference in the incidence of GIB in patients who underwent endoscopic evaluation pre-LVAD compared to post-LVAD GIB (32.6% vs. 39.1%, P = 0.64). Endoscopy was well-tolerated in this cohort, and argon plasma coagulation was the most commonly used intervention to achieve hemostasis.
According to our results, we recommend against routine pre-LVAD endoscopic screening. Instead, we suggest an individualized approach, where decisions are made on a case-by-case basis.
胃肠道出血（GIB）在左心室辅助装置（LVAD）患者中很常见，但LVAD植入前的最佳筛查方法仍不明确。本研究的目的是描述我们在该队列中LVAD植入前后内镜筛查及随后胃肠道出血的经验。
对2010年至2020年期间在圣卢克医院接受LVAD植入的所有患者进行回顾性研究。回顾数据以确定LVAD植入前1个月内进行的内镜检查的阳性率和安全性以及植入后1年内GIB的发生率。
共有167例LVAD患者符合纳入标准，23例接受了植入前内镜评估。在LVAD植入后的内镜检查中，血管发育异常的优势比（OR）显著更高，为9.41（95%置信区间（CI）：2.01 - 44.09），而消化性溃疡病或憩室出血等其他出血来源无显著差异。与LVAD植入后GIB相比，LVAD植入前接受内镜评估的患者GIB发生率无差异（32.6%对39.1%，P = 0.64）。该队列对内镜检查耐受性良好，氩等离子体凝固是最常用的止血干预措施。
根据我们的结果，我们不建议进行常规的LVAD植入前内镜筛查。相反，我们建议采用个体化方法，根据具体情况做出决定。
