P1972 - Evaluating the Necessity of Screening Colonoscopy in LVAD Candidates: A Retrospective Study

Fatimah H. Choudhary, MD, Luis Pina Martina, MD, Marc Fenster, MD, Snehal Patel, MD, Daniel Behin, MD
Montefiore Medical Center, Bronx, NY

Introduction: Screening colonoscopy is routinely performed in patients undergoing evaluation for left ventricular assist device (LVAD) implantation. However, current guidelines are inconsistent and there is limited data demonstrating the necessity of pre-LVAD colonoscopy in this comorbid population who carry increased procedural risk.

Methods: In this single center retrospective cohort study, we reviewed the charts of all patients who underwent LVAD implantation at Montefiore Medical Center in the Bronx, NY from 1/2019 to 8/2022, comparing the clinical outcomes of those who underwent pre-LVAD colonoscopy versus those who had no form of screening. Inclusion criteria were defined as: adults with end-stage heart failure undergoing evaluation for LVAD. Pediatric patients and those with incomplete electronic medical records were excluded. The primary outcome of our study was the prevalence of malignant and premalignant lesions in patients who underwent screening. The secondary outcomes included post-colonoscopy complications, comparison of post-LVAD GIB rates in both groups, and whether history of pre-LVAD GIB, pre-existing endoscopic findings, or post-LVAD method of anticoagulation had any significant correlation with GI bleeding rates.

Results: 96 patient charts were reviewed, of whom 43 were identified to have undergone pre-LVAD colonoscopy, 49 had no screening, and 4 were excluded. Of the patients who underwent pre-LVAD colonoscopy, 20 underwent polypectomy with pathology yielding 0% malignancy, 4% villous or tubulovillous adenoma, 64% tubular adenoma, 4% inflammatory, and 28% hyperplastic. No angioectasias or bleeding lesions were found. Of the 43 who underwent screening, 8 developed an AKI (18%) and 13 suffered from post-LVAD GI bleeding complications (8 Upper GIB, 3 Lower GIB, 2 unclear source), resulting in 1 patient death. Of the 49 who did not undergo screening, 8 had post-LVAD GI bleeding (3 Upper GIB, 2 Lower GIB, 3 unclear source), also resulting in 1 patient death. The difference in bleeding rates was not statistically significant.

Discussion: Our study suggests that screening colonoscopy prior to LVAD may not be necessary as the diagnostic yield (premalignant lesions) was low and it did not significantly reduce rates of GI bleeding post-implant. Further studies comparing colonoscopy to noninvasive screening methods such as FIT testing or CT colonography would be helpful to inform if the latter can be pursued as a safer alternative.


Disclosures:


Fatimah H. Choudhary, MD, Luis Pina Martina, MD, Marc Fenster, MD, Snehal Patel, MD, Daniel Behin, MD. P1972 - Evaluating the Necessity of Screening Colonoscopy in LVAD Candidates: A Retrospective Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.