613 Comparison of Clinical Outcomes in Traditional Gastrointestinal Hemorrhage Work-Up Versus Direct Utilization by Push Enteroscopy in Patients With a Left Ventricular Assist Device

Abstract

INTRODUCTION: Patients with left ventricular assisted devices (LVADs) are at considerable risk of gastrointestinal bleeding (GIB) of about 23%. A significant portion of GIB occur in the stomach, duodenum or small intestine as compared with lower intestinal tract. The traditional workup for such patients usually starts with an EGD ± colonoscopy, then proceeds with a small bowel evaluation if the initial workup is negative. This approach requires considerable time and effort which may lead to longer hospitalizations and multiple procedures. Our goal is to compare the traditional work up GIB with an innovative approach of performing push enteroscopy (PE) as the first diagnostic/therapeutic procedure. METHODS: This is a retrospective study was performed in Henry Ford Hospital in Detroit, MI. ICD-9 and ICD-10 diagnosis codes were used to generate a list of LVAD patients who were admitted with an overt GIB or worsening anemia in the period from 1/1/2013 to 12/25/2018. Our primary outcomes were the rate of detection of GIB lesion and all-cause mortality. Secondary outcome was the length of hospitalization. RESULTS: A total of 227 patients were reviewed. 89 patients were included (Mean age 61.36 years old, 75.28% were males). Most patients presented with either melena or worsening anemia without overt GIB. A total of 71 patients underwent the traditional approach at the first index endoscopy, whereas 18 patients started with PE ± colonoscopy. The source of GIB was detected at the first index endoscopy in 51 patients (36 traditional approach and 15 in PE approach). Arteriovenous malformation was the most common lesion detected and the two most common sites of bleeding were gastroduodenal followed by the small bowel. The PE approach was associated with a higher rate of GI site detection, OR 4.861 (95% CI (1.293-18.271), P 0.012), this was true, especially when patients presented with worsening anemia without overt bleeding, OR 11.2 (95% CI (1.202-104.33), P 0.015). There was no statistically significant difference between both approaches in terms of all-cause mortality (P 0.163). Patients in the PE approach did have a shorter hospital stay (x̅ (SD) 10.78 (13.97) days compared to 18.8 (25.58) days for the traditional approach) with P 0.034. CONCLUSION: PE is a safe procedure. It increases the GIB site detection and shortens the length of hospital stay when considered on the initial evaluation of LVAD patients presenting with GIB in general and worsening anemia in specific.