title: Utility of double-balloon enteroscopy in patients with left ventricular assist devices and obscure overt gastrointestinal bleeding.
abstract: Obscure overt gastrointestinal bleeding (OGIB) is a challenge in patients with left ventricular assist devices (LVADs). We evaluated the utility and safety of double-balloon enteroscopy (DBE) in patients with LVADs in an observational consecutive-patient cohort from a single tertiary referral center. Ten patients with LVADs underwent thirteen DBEs for obscure OGIB. The first OGIB event necessitating DBE occurred after a mean of 512 ± 363 days of LVAD support. All patients underwent DBE, eleven anterograde and two retrograde, with a mean insertion depth 176 ± 85 cm. Diagnostic yield was 69 % with the primary bleeding lesion most frequently found in the mid-bowel. The most common lesions were arteriovenous malformations. Therapeutic yield with argon plasma coagulation (APC), epinephrine injection, and/or hemoclip placement was 89 %. There were no procedure-related complications. DBE in patients with LVADs has good diagnostic yield and high therapeutic yield for obscure OGIB and is safe and well tolerated.
authors.affiliation: Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Edwards
authors.affiliation: Basil I. Hirschowitz Center of Endoscopic Excellence, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.
authors.forename: Klaus
authors.initials: K
authors.lastname: Mönkemüller
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.
authors.forename: Salpy V
authors.initials: SV
authors.lastname: Pamboukian
authors.affiliation: Division of Cardiothoracic Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: George
authors.affiliation: Basil I. Hirschowitz Center of Endoscopic Excellence, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Wilcox
authors.affiliation: Basil I. Hirschowitz Center of Endoscopic Excellence, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.
authors.forename: Shajan
authors.initials: S
authors.lastname: Peter
mesh_terms: D000368:Aged; D058582:Double-Balloon Enteroscopy / Q000009:adverse effects; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D016558:Hemostasis, Endoscopic; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008297:Male; D008551:Melena / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged