D0307 - Utility and Safety of Pre-LVAD Endoscopy in Preventing Gastrointestinal Bleeding in Left Ventricular Assist Device (LVAD) Recipients

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Wael T. Mohamed, MD

University of Missouri Kansas City School of Medicine
Kansas City, MO

Wael T. Mohamed, MD¹, Vinay Jahagirdar, MD², Mohamed K. Ahmed, MD¹, Harith Baharith, MD³, Jessica Heimes, DO⁴, Esmat Sadeddin, MD¹, Hassan Ghoz, MD¹, Brett Sperry, MD⁴, Wendell Clarkston, MD⁵
¹University of Missouri Kansas City School of Medicine, Kansas City, MO; ²University of Missouri, Kansas City, MO; ³University of Missouri, Kansas CIty, MO; ⁴Saint Luke's Hospital System - Mid America Heart Institute, Kansas City, MO; ⁵University of Missouri-Kansas City School of Medicine, Saint Luke's Hospital, Kansas City, MO

Introduction: Gastrointestinal bleeding (GIB) is a frequent complication in patients with a left ventricular assist device (LVAD). Small bowel angiodysplasias are the most common source of bleeding. The optimal approach to pre-screen patients before LVAD implantation remains unclear. The aim of this study is to describe pre-and-post-LVAD endoscopy findings.

Methods: A retrospective review was conducted among all patients who underwent LVAD implantation, at Saint Luke’s Hospital between 2010 and 2020. 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.

Results: Among 205 patients who received an LVAD, 167 met the inclusion criteria for this study and 23 underwent pre-implantation endoscopic evaluation. Modalities of pre-LVAD endoscopy included EGD 14/23 (60.9%), colonoscopy 9/23 (39.1%), enteroscopy 3/23 (13%), and capsule endoscopy 1/23 (4.3%), with the most frequently identified source of peptic disease. Of 56 patients who experienced post-LVAD bleeding, 55 underwent endoscopy where angiodysplasia was the most frequently identified source, though peptic disease, polyps, and diverticular bleeds were also common. Therapeutic interventions were successful in attaining hemostasis in almost all cases without adverse events. There was no difference in the rates of GI bleeding in patients who underwent endoscopic evaluation pre-LVAD (39.1% vs 32.6%, p=0.64).

Discussion: GIB is a common event following LVAD placement. Pre-LVAD endoscopic evaluation done within 1 month prior to implantation does not reduce the incidence of post-LVAD bleeding, and its role remains questionable.

Figure: Figure A. Incidence of GI bleeding in those who did and didn’t undergo pre-LVAD endoscopic evaluation.
Figure B. Diagnostic yield of endoscopy identifying source of bleeding within one year post-LVAD placement.

	Pre-LVAD (n=23)	Post-LVAD (n=55)
• Scope modality
EGD	14 (60.9%)	37 (67.3%)
Colonoscopy	9 (39.1%)	27 (49.1%)
Enteroscopy	3 (13.0%)	20 (36.4%)
Capsule	1 (4.3%)	4 (7.27%)
• Source of bleeding
Peptic disease	7 (30.4%)	19 (34.6%)
Angiodysplasia	2 (8.70%)	26 (47.3%)
Polyps	3 (13.0%)	14 (25.5%)
Hemorrhoids	3 (13.0%)	7 (12.7%)
Diverticulosis	5 (21.7%)	14 (25.5%)
Esophageal disease	2 (8.7%)	2 (3.64%)
Duodenal disease	4 (17.4%)	2 (3.64%)
Ischemic colitis	0 (0.0%)	2 (3.64%)
• Location of lesion
No source identified	5 (21.7%)	9 (16.3%)
Stomach	3 (13.0%)	27 (49.1%)
Small intestine	3 (13.0%)	25 (45.5%)
Large intestine	3 (13.0%)	30 (54.5%)
Ano-rectal	3 (13.0%)	8 (14.5%)

Table: Comparing diagnostic yield of pre vs post-LVAD endoscopy; for detecting possible sources of GI bleeding.

Disclosures:

Wael Mohamed indicated no relevant financial relationships.

Vinay Jahagirdar indicated no relevant financial relationships.

Mohamed Ahmed indicated no relevant financial relationships.

Harith Baharith indicated no relevant financial relationships.

Jessica Heimes indicated no relevant financial relationships.

Esmat Sadeddin indicated no relevant financial relationships.

Hassan Ghoz indicated no relevant financial relationships.

Brett Sperry indicated no relevant financial relationships.

Wendell Clarkston indicated no relevant financial relationships.

Wael T. Mohamed, MD¹, Vinay Jahagirdar, MD², Mohamed K. Ahmed, MD¹, Harith Baharith, MD³, Jessica Heimes, DO⁴, Esmat Sadeddin, MD¹, Hassan Ghoz, MD¹, Brett Sperry, MD⁴, Wendell Clarkston, MD⁵. D0307 - Utility and Safety of Pre-LVAD Endoscopy in Preventing Gastrointestinal Bleeding in Left Ventricular Assist Device (LVAD) Recipients, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.