Video capsule endoscopy in left ventricular assist device recipients with obscure gastrointestinal bleeding

Table 1 Characteristics and outcomes of left ventricular assist device recipients undergoing video capsule endoscopy n (%)

	Total, n = 30	Positive study, n = 12	Negative study, n = 18	P value
Age (yr)	60.1 ± 10.2	62.6 ± 8.8	58.4 ± 10.9	0.27
Female	6 (20.0)	4 (33.3)	2 (11.1)	0.18
Charlson comorbidity index	4.7	5	4.6	0.70
History of GIB prior to LVAD	3 (10.0)	2 (16.7)	1 (5.6)	0.55
LVAD implant to GIB (mo)	4.8 ± 6.0	5.5 ± 7.0	4.4 ± 5.3	0.65
Overt GIB	23 (76.7)	8 (66.7)	15 (83.3)	0.39
Antiplatelet agents	26 (86.7)	10 (83.3)	16 (88.9)	1.00
Anticoagulants	28 (93.3)	11 (91.7)	17 (94.4)	1.00
Endoscopies prior to VCE (number)	3.2 ± 1.7	3.5 ± 1.9	3.0 ± 1.7	0.46
Length of stay (d)	13.1 ± 12.5	20.3 ± 17.6	8.3 ± 2.3	0.04
Follow-up (mo)	11.6 ± 9.6	9.2 ± 9.3	13.2 ± 9.7	0.28
Recurrent GIB rate	16 (53.3)	6 (50)	10 (55.6)	1.00
Endoscopies after VCE (number)	1.7 ± 2.2	1.8 ± 1.8	1.7 ± 2.5	0.97
Mortality rate	10 (33.3)	4 (33.3)	6 (33.3)	0.90

GIB: Gastrointestinal bleeding; LVAD: Left ventricular assist device; VCE: Video capsule endoscopy.

Table 2 Locations and findings of positive video capsule endoscopy studies n (%)

	Patients (n = 12)
Locations of positive VCE findings
Stomach and duodenum	2 (16.7)
Small intestine	9 (75.0)
Colon	1 (8.3)
Findings of positive VCE studies
Small intestinal bleeding with no source or lesion identified (2 in the duodenum, 4 in the jejunum)	6 (50.0)
Angiodysplasia (1 in the duodenum, 3 in the small bowel)	4 (33.3)
Colonic bleeding with no source or lesion identified	1 (8.3)
Gastric ulcer	1 (8.3)

VCE: Video capsule endoscopy.

Table 3 Clinical course and management of left ventricular assist device recipients with positive video capsule endoscopy studies

No.	Age (yr) and Sex	Presentation	Endoscopic findings and interval prior to VCE (d)	VCE findings	Endoscopic findings and interval after VCE (d)	Recurrent bleeding and interval after VCE (mo)	Management for recurrent bleeding
1	62 M	Anemia	Rectal polyp (2)	Gastric ulcer	N/A	Melena (21)	EGD: GU with visible vessel s/p hemoclip
2	57 M	Anemia	Gastritis, colonic polyp (24)	Duodenal angiodysplasia	PE: Gastritis (2)	No	N/A
3	73 M	Melena	Gastric and jejunal angiodysplasia (4)	Small bowel angiodysplasia	N/A	Melena (1.7)	PE: Bleeding jejunal angiodysplasia s/p APC
4	53 F	Melena	Blood in the terminal ileum (0)	Small bowel angiodysplasia	PE: Bleeding jejunal angiodysplasia s/p APC + hemoclip (2)	No	N/A
5	61 M	Anemia	Colonic diverticulosis, hemorrhoids (3)	Small bowel angiodysplasia	N/A	No	N/A
6	53 M	Anemia	Duodenitis (4)	Stomach and small bowel bleeding	PE: Clean base GU (2)	Melena (0.5)	PE: Gastritis and fresh blood in duodenum without lesions identified
7	70 F	Melena	Gastric angiodysplasia s/p APC (3)	Small bowel bleeding	N/A	Melena (11.4)	PE: DLBCL of stomach
8	61 F	Hematochezia	Sigmoid angiodysplasia s/p APC (2)	Small bowel bleeding	PE: Normal; SBE: Bleeding jejunal angiodysplasia s/p APC+ hemoclip (2)	Hematochezia (11.2)	PE: Gastritis; C-scope: Bleeding sigmoid angiodysplasia s/p APC + hemoclip
9	52 M	Melena	Colonic diverticulosis, hemorrhoids (1)	Small bowel bleeding	N/A	No	N/A
10	59 M	Melena	Duodenal angiodysplasia s/p APC and hemoclip (5)	Small bowel bleeding	PE: Bleeding jejunal angiodysplasia s/p heater probe + APC; SBE: Nonbleeding jejunal angiodysplasia s/p APC (6)	Anemia requiring transfusion (0.7)	C-scope: Bleeding Cecal angiodysplasia s/p hemoclip
11	75 M	Melena	Colonic angiodysplasia s/p hemoclip (6)	Small bowel bleeding	PE: Gastric Dieulafoy’s lesion s/p hemoclip; SBE: Bleeding jejunal angiodysplasia s/p APC + hemoclip (2)	No	N/A
12	76 F	Melena	Normal (4)	Colonic bleeding	N/A	No	N/A

APC: Argon plasma coagulation; C-scope: Colonoscopy; DLBCL: Diffuse large B-cell lymphoma; EGD: Esophagogastroduodenoscopy; F: Female; GU: Gastric ulcer; M: Male; N/A: Not applicable; PE: Push enteroscopy; SBE: Single balloon enteroscopy; VCE: Video capsule endoscopy.

Table 4 Previous studies of video capsule endoscopy in left ventricular assist device recipients

Study and the year published	No. of VCE	Diagnostic yield (%)	Findings	Remarks
Girelli et al[18], 2006	1	N/A	No bleeding identified	No follow up reported
Garatti et al[15], 2006	1	N/A	No bleeding identified	No recurrent GIB; received heart transplantation
Seow et al[17], 2006	1	N/A	Duodenal and jejunal angiodysplasia	Push enteroscopy + Octreotide + Sucralfate; no follow up reported
Fenkel et al[16], 2007	1	N/A	Small bowel angiodysplasia	No intervention; no follow up reported
Daas et al[14], 2008	1	N/A	Mid-small bowel active bleeding	Intraoperative enteroscopy;no follow up reported
Bechtel et al[19], 2010	1	N/A	Bleeding in cecum	Colonoscopy; no follow up reported
Elmunzer et al[6], 2011	13	4 (30.8)	3 jejunal angiodysplasias, 1 duodenal Dieulafoy’s lesion	1 recurrent bleeding from the same lesion
Meyer et al[22], 2012	5	4 (80.0)	2 jejunal angiodysplasia, 1 cecal ulcer, 1 jejunal mass	1 colonoscopy; 2 SBE; 1 angiography; no follow up reported
Tarzia et al[13], 2013	1	N/A	Small bowel angiodysplasia and small bowel Dieulafoy’s lesion	DBE; no follow up reported

DBE: Double balloon enteroscopy; GIB: Gastrointestinal bleeding; N/A: Not applicable; SBE: Single balloon enteroscopy; VCE: Video capsule endoscopy.