Title: Capsule Endoscopy in Patients with Left Ventricular Assist Devices is Safe and Effective
Background/Aims: Capsule endoscopy (CE) is a well-established modality for diagnosis of
obscure gastrointestinal bleeding (GIB). Obscure GIB in patients with left ventricular assist
devices (LVAD) is not unusual. The safety and efficacy of CE in patients with LVAD are
unknown. The aims of this study are to define the safety and efficacy of CE in patients with
LVAD.
Methods: A retrospective chart review of all patients with LVAD undergoing CE at University of
Minnesota Medical Center, Minneapolis, Minnesota between January 2007 and August 2014
was performed. 33 CE studies performed in 24 patients were identified and reviewed for
demographic, laboratory, and CE study data in addition to subsequent medical and endoscopic
management.
Results: A total of 34 CE studies were performed in 24 patients. Mean age at time of first CE
was 67 years and 20 patients (83%) were male. Mean duration of LVAD implantation was 1.5
years (SD = 1.8 years). The indications for CE were obscure occult GIB in 3 cases, obscure
overt GIB in 24 and anemia in 6. CE findings included active bleeding in 12 cases (36%). A
potential source was visualized in 6 of these. When active bleeding was not seen on CE, a high
potential source (AVM, ulceration, tumor) was found in 3 and an intermediate potential source
(red spots, erosions) in 3. Active bleeding and potential sources were found in the stomach (n =
3) and small bowel (n = 15). The capsule failed to leave the stomach in 2 cases. Mean small
bowel transit time was 3 hours 44 minutes. No cardiac device malfunction occurred and no
capsules were retained. Small bowel image capture was incomplete in 3 CE studies. Medical
intervention was the most common management strategy after CE. Medical management was
changed after 25 of 34 CE studies (76%). CE findings were not associated with a change in
medical management (p = 0.69). Endoscopy was performed after CE in 9 patients (27%). Eight
of these patients displayed active bleeding on CE and 1 patient had a high potential source. In
those patients with active bleeding 6 (75%) were found to have a bleeding source during
endoscopy. Sources were an AVM in 4, Dieulafoy lesion in 1 and an indeterminate lesion in 1.
Six-month follow up was available in 30 patients. At six-month follow up 10 patients rebled.
Positive capsule endoscopy findings were not associated with rebleeding (p = 0.79). 1 patient
died during follow up but it was not related to GIB.
Conclusions: CE is safe in patients with LVAD. CE is an effective test for detection of bleeding
source in patients with LVAD. Medical management was changed after CE in the majority of
cases but CE findings were not associated with this change. Active bleeding during CE can later
be successfully treated endoscopically. CE findings are not associated with rebleeding risk. This
is the largest retrospective review study of CE in patients with LVAD.