Pre-left ventricular assist device endoscopic evaluation does not reduce the risk of later gastrointestinal bleeding: a multicenter study

Jiahao Peng; Samanthika Devalaraju; Mohamed Azab; William T. Cates; Molly Stone; Jonathan Reichstein; Sneha Shaha; Subhasis Chatterjee; Andrew B. Civitello; Mourad H. Senussi; B. Joseph Elmunzer; Michael Volk; Wasseem Skef

Authors Jiahao Peng, Samanthika Devalaraju, Mohamed Azab, William T. Cates, Molly Stone, Jonathan Reichstein, Sneha Shaha, Subhasis Chatterjee, Andrew B. Civitello, Mourad H. Senussi, B. Joseph Elmunzer, Michael Volk, Wasseem Skef.

Abstract

Background Gastrointestinal bleeding (GIB) is a common complication after placement of a left ventricular assist device (LVAD). Some institutions attempt to mitigate post-LVAD GIB using preoperative endoscopy. Our study evaluated whether preoperative endoscopy was associated with a lower risk of post-LVAD GIB.

Methods This was a multicenter cohort study of patients who underwent LVAD insertion from 2010-2019 at 3 academic sites. A total of 398 study participants were categorized based on whether they underwent preoperative endoscopy or not. The follow-up period was 1 year and the primary outcome was GIB. Secondary outcomes were severe bleeding and intraprocedural complications.

Results A total of 114 patients experienced GIB within 1 year, with a higher rate in the endoscopy cohort (36.4% vs. 24.8%, P=0.015). After adjusting for covariables, the endoscopy cohort remained at increased risk of GIB (adjusted odds ratio 1.77, 95% confidence interval 1.05-2.976; P=0.032). Severe bleeding was common (47.4%). Arteriovenous malformations (48 cases) and peptic ulcer disease (17 cases) were the most identified sources of GIB. Only 1 minor adverse event occurred during preoperative endoscopy.

Conclusions Our study suggests that pre-LVAD endoscopy is associated with a higher risk of GIB post LVAD, despite controlling for confounders. While this was an observational study and may not have captured all confounders, it appears that endoscopic screening may not be warranted.

Keywords Heart-assist devices, gastrointestinal hemorrhage, endoscopy

Ann Gastroenterol 2024; 37 (3): 313-320