Limited usefulness of endoscopic evaluation in patients with continuous-flow left ventricular assist devices and gastrointestinal bleeding
| Autor: | Anusorn Thanataveerat, A. Reshad Garan, Yoshifumi Naka, Pauline Trinh, Paolo C. Colombo, Reuben J. Garcia-Carrasquillo, Alberto Pinsino, L. Effner, Veli K. Topkara, G. Parkis, Jiho Han, Tamas A. Gonda, Christian Brooks, Hiroo Takayama, Ryan T. Demmer, B. Cagliostro, Koji Takeda, Jordan E. Axelrad, Melana Yuzefpolskaya, Ivonne Ramirez |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Gastrointestinal bleeding Cost-Benefit Analysis Columbia university 030204 cardiovascular system & hematology Endoscopy Gastrointestinal 03 medical and health sciences Postoperative Complications 0302 clinical medicine Humans Medicine In patient Retrospective Studies Transplantation medicine.diagnostic_test business.industry Continuous flow Middle Aged medicine.disease Occult Endoscopy Female 030211 gastroenterology & hepatology Surgery Heart-Assist Devices Radiology Gastrointestinal Hemorrhage Cardiology and Cardiovascular Medicine business Resource utilization |
| Zdroj: | The Journal of Heart and Lung Transplantation. 37:723-732 |
| ISSN: | 1053-2498 |
| Popis: | Background Gastrointestinal bleeding (GIB) is a frequent cause of re-admission in patients with continuous-flow left ventricular assist devices (CF-LVADs) and is associated with multiple endoscopic procedures and high resource utilization. Our aim was to determine the diagnostic and therapeutic yield of endoscopy and to develop a more cost-effective approach for the management of GIB in CF-LVAD recipients. Methods We retrospectively reviewed 428 patients implanted with a CF-LVAD between 2009 and 2016 at the Columbia University Medical Center and identified those hospitalized for GIB. Patients were categorized into upper GIB (UGIB), lower GIB (LGIB) and occult GIB (OGIB), based on clinical presentation. Results Eighty-seven CF-LVAD patients underwent a total of 164 GIBs, resulting in 239 endoscopies. Index presentation was consistent with UGIB in 30 (34.5%), LGIB in 19 (21.8%) and OGIB in 38 (43.7%) patients. On the first GIB, 147 endoscopies localized a bleeding source in 49 (30%), resulting in 24 (16.3%) endoscopic interventions. Of 45 lesions identified, arteriovenous malformations (AVMs) were the most common (22, 48.9%). A gastric or small bowel source (HR 2.8, p = 0.003) and an endoscopic intervention (HR 1.9, p = 0.04) predicted recurrent GIB. The proposed algorithm may reduce the number of endoscopic procedures by 45% and costs by 35%. Conclusions Occult GIB is the most common presentation in CF-LVAD patients and carries the lowest diagnostic and therapeutic yield of endoscopy. Performing an intervention was among the strongest predictors of recurrent GIB. Our proposed algorithm may decrease the number of low-yield procedures and improve resource utilization. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|