Abstract
To the Editor: We report the safe use of capsule endoscopy in the detection of obscure GI bleeding in a 59-year-old male patient with ischemic cardiomyopathy supported by a nonpulsatile axial–flow Jarvik 2000 left ventricular assist device (LVAD) (Jarvik Heart Inc, New York, NY). The patient presented with melena and had undergone previous gastroscopy and colonoscopy without localization of a bleeding source. The detection of distal duodenal and proximal jejunal lesions at capsule endoscopy led to a therapeutic push enteroscopy. Endoscopic therapy (application of argon plasma coagulation) and pharmacologic treatment (subcutaneous octreotide 3 times a day and peroral sucralfate) resulted in the cessation of bleeding. No cardiac complications arose from the use of the capsule endoscopy system. GI bleeding because of arteriovenous malformations in patients supported by such devices was described by Letsou et al.1Letsou G.V. Shah N. Gregoric I.D. et al.Gastrointestinal bleeding from arteriovenous malformations in patients supported by the Jarvik 2000 axial-flow left ventricular assist device.J Heart Lung Transplant. 2005; 24: 105-109Abstract Full Text Full Text PDF PubMed Scopus (173) Google Scholar They proposed that diminished pulsatility during support with the Jarvik 2000 may result in the same altered intestinal physiology seen in aortic stenosis. In this case series, 2 of the 3 patients required exploratory surgery to identify and treat small-intestinal sources of bleeding. The third patient underwent nuclear imaging, revealing small-intestinal arteriovenous malformations, and the patient was treated conservatively. We suggest that capsule endoscopy is safe and can be used in the diagnostic algorithm of obscure GI bleeding in such patients. It permits detection of lesions in the reach of a therapeutic enteroscope, negating the need for more invasive tests, including mesenteric angiography, exploratory laparotomy, and on-table enteroscopy.
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