Safety of Gastrointestinal Endoscopic Procedures Performed on Patients with Ventricular Assist Devices (VADs): A Single Center Experience

Abstract

Purpose: VADs support many cardiac patients as a bridge to recovery, cardiac transplantation, or as a destination therapy. Patients with VADs frequently require gastrointestinal (GI) endoscopic procedures. Indications most commonly include colon cancer screening for transplant clearance, and the evaluation of GI bleeding, which is common in this population due to the use of multiple anticoagulant/antiplatelet use. However, these patients are perceived as particularly high risk for endoscopy, due to hemodynamic instability, anticoagulation/antiplatelet use, and the presence of other comorbidities. We present a single center experience of 83 patients with VADs who underwent a variety of endoscopic procedures. We have focused primarily on evaluating the safety of these procedures in LVAD patients, in terms of complications and mortality. Methods: A retrospective chart review of all patients with Ventricular Assist Devices (VADs) who have undergone colonoscopy, esophagogastroduodenoscopy (EGD), push enteroscopy, PEG placement, endoscopic ultrasound (EUS), double balloon endoscopy or video capsule endoscopy at the University of Rochester Medical Center from 2002 until 2009. The procedure reports and charts were analyzed to evaluate for any complications that occurred during the procedure or within 24 hours. Specific endoscopic interventions performed included cold mucosal biopsy, jumbo forceps biopsy, cold snare, hot snare, and FNA. Results: A total of 170 patient charts were reviewed, representing all patients in which VADs have been placed at our institution between 2002 and 2009. Only patients in which a GI endoscopic procedure was performed at our institution were further analyzed. A total of 104 procedures were performed in 83 VAD patients. There were no deaths related to endoscopic complications. The only significant complication occurred in a single patient who underwent EUS with FNA (enlarging perigastric lymphadenopathy), in whom anticoagulation could not be held for the customary interval. That patient developed a perigastric hematoma and anemia following the procedure, but recovered with conservative management. Conclusion: Our experience suggests that gastrointestinal endoscopic procedures can be performed safely in patients with VADs, despite the hemodynamic alterations, comorbidities, and anticoagulation/antiplatelet issues which make this population more challenging.