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

Amornsawadwattana, Surachai; Nassif, Michael E.; Raymer, David S.; LaRue, Shane J.; Chen, Chien-Huan

doi:10.3748/wjg.v22.i18.4559

Cited by 22 publications

(19 citation statements)

References 34 publications

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“…According to the American College of Gastroenterology guidelines, the patients with an upper GI bleed should undergo endoscopy within 24 hours, following resuscitative efforts to optimize hemodynamic parameters [30]. When both these measures fail, video capsule endoscopy should be performed as it has been shown to have a high bleeding detection rate (about 40% of cases, mostly confined to the proximal small intestine) [38]. However, video capsule endoscopy is not therapeutic and may result in an increased hospital stay of the patient.…”

Section: Mild To Moderate Bleedingmentioning

confidence: 99%

Clinical Approach to Manage Gastrointestinal Bleeding with a Left Ventricular Assist Device (LVAD)

Ahsan¹,

Faraz²,

Mehmood³

et al. 2019

Cureus

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Left ventricular assist devices (LVADs) are an exceedingly important form of mechanical support for patients with end-stage heart failure. LVADs can be utilized both as a bridge to cardiac transplant and also as a definitive treatment. However, a few complications are associated with LVAD placement, the most common and cumbersome of which is gastrointestinal (GI) bleeding with an incidence of about 30%. These bleeding events often require transfusion therapy, but they are rarely fatal. The etiologies of GI bleeding following LVAD are multifactorial and include unstable hemodynamics, an acquired von Willebrand factor (vWf) deficiency, impaired platelet aggregation, and activation of fibrinolytic systems. The treatment of choice in LVAD implantation-associated GI bleeding is endoscopy, which plays a vital role in both its diagnosis and management. Even so, its effectiveness in controlling post-LVAD implantation GI bleeding is still poorly ascertained. In this article, we will review the use of medication and alterations in the LVAD setting to prevent the occurrence of GI bleeding, as well as the findings of previously reported literature on LVAD implantation-associated GI bleeding.

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Section: Mild To Moderate Bleedingmentioning

confidence: 99%

Clinical Approach to Manage Gastrointestinal Bleeding with a Left Ventricular Assist Device (LVAD)

Ahsan¹,

Faraz²,

Mehmood³

et al. 2019

Cureus

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“…Nevertheless, users of VCE estimated EMI between capsules and cardiac devices possibly being life-threatening for patients. Since the introduction of VCE, several in vitro and in vivo studies analyzed EMI between VCE (PillCam and EndoCapsule) and PMs ( in vitro :[42-44]; in vivo :[44-54]), implantable cardioverter defibrillators (ICD) ( in vitro :[55,56]; in vivo :[45-48,54,56-59]) and left ventricular assist devices (LVAD) ( in vitro : none, in vivo :[52,60-68]).…”

Section: Vce In Patients With Implantable Cardiac Devicesmentioning

confidence: 99%

“…EMI between VCE and LVAD was investigated in 10 in-vivo studies[52,60-68]. No interference was observed in any of the studies.…”

Section: Vce In Patients With Implantable Cardiac Devicesmentioning

confidence: 99%

Contraindications for video capsule endoscopy

Bandorski¹,

Kurniawan²,

Baltes³

et al. 2016

WJG

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Video capsule endoscopy (VCE) has been applied in the last 15 years in an increasing field of applications. Although many contraindications have been put into perspective, some precautions still have to be considered. Known stenosis of the gastrointestinal tract is a clear contraindication for VCE unless surgery is already scheduled or at least has been considered as an optional treatment modality. In patients with a higher incidence of stenosis, as in an established diagnosis of Crohn’s disease, clinical signs of obstruction, prior radiation or surgical small bowel resection, a preceding test with the self-dissolving patency capsule can override this contraindication. Endoscopic placement of the capsule should be considered in patients with swallowing disorders to avoid aspiration. Esophageal or gastric motility disorders may require endoscopic capsule transport or application of prokinetics if the real-time viewer proofs delayed transit. In pregnant women, VCE should be restricted to urgent cases where diagnosis cannot be postponed after delivery, as data on safety are missing. There is theoretical and clinical evidence that patients with implanted cardiac devices such as a pacemaker, cardioverters or left heart assist devices, can safely undergo VCE in spite of still existing contraindication by manufacturers. Children from the age of 2 years have safely undergone VCE. Although video capsules are not proven safe with magnetic resonance imaging (MRI), first single cases of patients incidentally undergoing MRI with an incorporated capsule have been reported, showing susceptibility artifacts but no signs of clinical harm.

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“…There is a paucity of data detailing the safety and use of WCE in patients with implantable cardiac devices . The use of some of these cardiac devices, most notably LVADs, increases the risks of gastrointestinal bleeding, with as much as 20–40% of LVAD recipients developing gastrointestinal bleeds . With up to 65% of these bleeds coming from an unidentified source after completing upper and lower endoscopies, use of WCE is increasingly relevant in these patients …”

Section: Introductionmentioning

confidence: 99%

“…8,9 The use of some of these cardiac devices, most notably LVADs, increases the risks of gastrointestinal bleeding, with as much as 20-40% of LVAD recipients developing gastrointestinal bleeds. 10 With up to 65% of these bleeds coming from an unidentified source after completing upper and lower endoscopies, use of WCE is increasingly relevant in these patients. 11,12 There is no consensus on how to best monitor the true short-and long-term safety of this procedure and subsequent patient cardiac safety events.…”

Section: Introductionmentioning

confidence: 99%

Safety of wireless capsule endoscopy in patients with implantable cardiac devices

et al. 2019

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Background and Aim Wireless capsule endoscopy (WCE) has become an increasingly utilized imaging modality for the evaluation of gastrointestinal bleeding. There is a paucity of data evaluating the safety and use of WCE in patients with implantable cardiac devices. Methods A retrospective chart review of all patients who had a WCE at Loyola University Medical Center in Maywood, IL, USA completed between January 2007 and December 2016 identified patients with internal cardiac devices and obscure gastrointestinal bleeding. Patient WCE footage was viewed in its entirety before creating a final report to ensure no gaps in footage and video quality. Results No patient complaints were documented during the 8‐h procedure duration, and there were no cardiac abnormalities noted on telemetry. There were no device‐related complications documented in the 30‐day postprocedure time period. Postprocedure analysis of the WCE recordings demonstrated no interference in WCE image quality (loss of images or gaps in video) or duration. Conclusions There is no significant interference between WCE and implantable cardiac devices, and it appears to be safe to use.

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

Abstract: VCE can be safely performed in LVAD recipients with a diagnostic yield of 40%. VCE does not affect recurrent bleeding in LVAD patients regardless of findings.

Cited by 22 publications

References 34 publications

Clinical Approach to Manage Gastrointestinal Bleeding with a Left Ventricular Assist Device (LVAD)

Clinical Approach to Manage Gastrointestinal Bleeding with a Left Ventricular Assist Device (LVAD)

Contraindications for video capsule endoscopy

Safety of wireless capsule endoscopy in patients with implantable cardiac devices

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