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The Diagnostic Yield of Repeated Endoscopic Evaluation in Patients with Gastrointestinal Bleeding and Left Ventricular Assist Devices.

Publication ,  Journal Article
Dakik, HK; McGhan, AA; Chiu, S-T; Patel, CB; Milano, CA; Rogers, JG; Chow, S-C; Wild, DM
Published in: Dig Dis Sci
June 2016

INTRODUCTION: Left ventricular assist devices (LVADs) are increasingly common in patients with advanced heart failure. GI bleeding (GIB) occurs in 20-30 % of these patients and can arise anywhere in the GI tract. Given the high rates of GIB in this population, our aim was to determine the diagnostic yield of repeated endoscopic evaluation in these patients. METHODS: We performed a retrospective review of all 257 patients who had LVADs placed between 2008 and 2013 at Duke University Hospital and identified all patients who underwent any endoscopic evaluation for GIB. RESULTS: Of the 257 patients with LVADs placed, 78 (30 %) underwent at least one endoscopy for GIB. A source was identified in 36 % of cases, most commonly angioectasias (53.6 %). Treatment was performed in 67.9 % of patients and hemostasis was achieved in all. 64.1 % of the cohort underwent a second endoscopy for GIB. 42.9 % of these exams revealed a bleeding source. Endoscopic treatment was employed in 76.2 %. 38.5 % of the cohort underwent a third endoscopic exam for bleeding and a source was identified in 53.3 % with angioectasias remaining most common (56.3 %). By Fisher's exact and Chi-square testing, only the presence of a bleeding source (p = 0.0034) and use of hemostatic therapy (p = 0.0127) on the index examination were significantly associated with re-bleeding. CONCLUSIONS: GIB is common in patients with LVADs. The diagnostic and therapeutic yield of endoscopy is remains high with repeated interventions. Despite these high yields, a large portion of the cohort requires repeated interventions for recurrent bleeding.

Duke Scholars

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Published In

Dig Dis Sci

DOI

EISSN

1573-2568

Publication Date

June 2016

Volume

61

Issue

6

Start / End Page

1603 / 1610

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Heart-Assist Devices
  • Gastrointestinal Hemorrhage
  • Gastroenterology & Hepatology
  • Female
  • Endoscopy, Gastrointestinal
 

Citation

APA
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MLA
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Dakik, H. K., McGhan, A. A., Chiu, S.-T., Patel, C. B., Milano, C. A., Rogers, J. G., … Wild, D. M. (2016). The Diagnostic Yield of Repeated Endoscopic Evaluation in Patients with Gastrointestinal Bleeding and Left Ventricular Assist Devices. Dig Dis Sci, 61(6), 1603–1610. https://doi.org/10.1007/s10620-015-4028-7
Dakik, Hassan K., Alyson A. McGhan, Shih-Ting Chiu, Chetan B. Patel, Carmelo A. Milano, Joseph G. Rogers, Shein-Chung Chow, and Daniel M. Wild. “The Diagnostic Yield of Repeated Endoscopic Evaluation in Patients with Gastrointestinal Bleeding and Left Ventricular Assist Devices.Dig Dis Sci 61, no. 6 (June 2016): 1603–10. https://doi.org/10.1007/s10620-015-4028-7.
Dakik HK, McGhan AA, Chiu S-T, Patel CB, Milano CA, Rogers JG, et al. The Diagnostic Yield of Repeated Endoscopic Evaluation in Patients with Gastrointestinal Bleeding and Left Ventricular Assist Devices. Dig Dis Sci. 2016 Jun;61(6):1603–10.
Dakik, Hassan K., et al. “The Diagnostic Yield of Repeated Endoscopic Evaluation in Patients with Gastrointestinal Bleeding and Left Ventricular Assist Devices.Dig Dis Sci, vol. 61, no. 6, June 2016, pp. 1603–10. Pubmed, doi:10.1007/s10620-015-4028-7.
Dakik HK, McGhan AA, Chiu S-T, Patel CB, Milano CA, Rogers JG, Chow S-C, Wild DM. The Diagnostic Yield of Repeated Endoscopic Evaluation in Patients with Gastrointestinal Bleeding and Left Ventricular Assist Devices. Dig Dis Sci. 2016 Jun;61(6):1603–1610.
Journal cover image

Published In

Dig Dis Sci

DOI

EISSN

1573-2568

Publication Date

June 2016

Volume

61

Issue

6

Start / End Page

1603 / 1610

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Heart-Assist Devices
  • Gastrointestinal Hemorrhage
  • Gastroenterology & Hepatology
  • Female
  • Endoscopy, Gastrointestinal