caa a22 4500 445797843 CHVBK 20180317145131.0 cr unu---uuuuu 170323e20111101xx s 000 0 eng 10.1007/s10620-011-1828-2 doi (NATIONALLICENCE)springer-10.1007/s10620-011-1828-2 Endoscopic Findings and Clinical Outcomes in Ventricular Assist Device Recipients with Gastrointestinal Bleeding [Elektronische Daten] [B. Joseph Elmunzer, Kunjali Padhya, Jason Lewis, Amol Rangnekar, Sameer Saini, Shanti Eswaran, James Scheiman, Francis Pagani, Jonathan Haft, Akbar Waljee] Background: Gastrointestinal bleeding (GIB) is an important clinical problem in recipients of ventricular assist devices (VAD), although data pertaining to the endoscopic evaluation and management of this complication are limited in the medical literature. Aims: We sought to identify the most common endoscopic findings in VAD recipients with GIB, and to better define the diagnostic and therapeutic utility of endosopy for this patient population. Methods: Twenty-six subjects with VAD and overt GIB were retrospectively identified. Clinical and endoscopic data were abstracted for each subject on to standardized forms in duplicate and independent fashion. Raw data and descriptive statistics were reported. Results: Non-peptic vascular lesions were the most common cause of GIB. A definitive cause of bleeding was identified by endoscopy in almost 60% of subjects. Endoscopic hemostasis was achieved in 14/15 patients in whom bleeding did not stop spontaneously. Rebleeding occurred in 50% of subjects and was successfully retreated or stopped spontaneously in all cases. Colonoscopy did not establish a definitive diagnosis or deliver hemostatic therapy in any case. Conclusions: Vascular malformations account for the overwhelming majority of bleeding lesions in VAD patients with GIB. Endoscopy seems to be a safe and effective tool for diagnosing, risk stratifying, and treating this patient population, although multiple endoscopies may be necessary before therapeutic success, and the incidence of rebleeding is high. A prospective multi-center registry is necessary to establish evidence-based management algorithms for VAD recipients with GIB. Springer Science+Business Media, LLC, 2011 Ventricular assist device nationallicence Gastrointestinal hemorrhage nationallicence Endoscopic evaluation nationallicence Endoscopic hemostasis nationallicence Joseph Elmunzer B. Division of Gastroenterology, University of Michigan Medical Center, 3912 Taubman Center, 48109, Ann Arbor, MI, USA aut Padhya Kunjali Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA aut Lewis Jason Division of Gastroenterology, University of Michigan Medical Center, 3912 Taubman Center, 48109, Ann Arbor, MI, USA aut Rangnekar Amol Division of Gastroenterology, University of Michigan Medical Center, 3912 Taubman Center, 48109, Ann Arbor, MI, USA aut Saini Sameer Division of Gastroenterology, University of Michigan Medical Center, 3912 Taubman Center, 48109, Ann Arbor, MI, USA aut Eswaran Shanti Division of Gastroenterology, University of Michigan Medical Center, 3912 Taubman Center, 48109, Ann Arbor, MI, USA aut Scheiman James Division of Gastroenterology, University of Michigan Medical Center, 3912 Taubman Center, 48109, Ann Arbor, MI, USA aut Pagani Francis Division of Cardiac Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA aut Haft Jonathan Division of Cardiac Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA aut Waljee Akbar Division of Gastroenterology, University of Michigan Medical Center, 3912 Taubman Center, 48109, Ann Arbor, MI, USA aut Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/11(2011-11-01), 3241-3246 0163-2116 56:11<3241 2011 56 10620 https://doi.org/10.1007/s10620-011-1828-2 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10620-011-1828-2 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Joseph Elmunzer B. Division of Gastroenterology, University of Michigan Medical Center, 3912 Taubman Center, 48109, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Padhya Kunjali Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Lewis Jason Division of Gastroenterology, University of Michigan Medical Center, 3912 Taubman Center, 48109, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Rangnekar Amol Division of Gastroenterology, University of Michigan Medical Center, 3912 Taubman Center, 48109, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Saini Sameer Division of Gastroenterology, University of Michigan Medical Center, 3912 Taubman Center, 48109, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Eswaran Shanti Division of Gastroenterology, University of Michigan Medical Center, 3912 Taubman Center, 48109, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Scheiman James Division of Gastroenterology, University of Michigan Medical Center, 3912 Taubman Center, 48109, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Pagani Francis Division of Cardiac Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Haft Jonathan Division of Cardiac Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Waljee Akbar Division of Gastroenterology, University of Michigan Medical Center, 3912 Taubman Center, 48109, Ann Arbor, MI, USA aut NATIONALLICENCE 773 0- Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/11(2011-11-01), 3241-3246 0163-2116 56:11<3241 2011 56 10620 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer