Endoscopy 2014; 46(11): 986-991
DOI: 10.1055/s-0034-1377512
Case series
© Georg Thieme Verlag KG Stuttgart · New York

Utility of double-balloon enteroscopy in patients with left ventricular assist devices and obscure overt gastrointestinal bleeding

Adam L. Edwards
1  Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
,
Klaus Mönkemüller
2  Basil I. Hirschowitz Center of Endoscopic Excellence, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
,
Salpy V. Pamboukian
3  Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
,
James F. George
4  Division of Cardiothoracic Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
,
C. M. Wilcox
2  Basil I. Hirschowitz Center of Endoscopic Excellence, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
,
Shajan Peter
2  Basil I. Hirschowitz Center of Endoscopic Excellence, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
› Author Affiliations
Further Information

Publication History

submitted 11 March 2014

accepted after revision 30 May 2014

Publication Date:
07 October 2014 (eFirst)

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.

Tables e1 and e2 and Figure e2