Safety of Capsule Endoscopy With Implantable Cardiac Devices
Safety of Capsule Endoscopy With Implantable Cardiac Devices
Hello. I am Dr. David Johnson, Professor of Medicine, and Chief of Gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia.
Capsule endoscopy -- a radiofrequency transmission-based device -- is contraindicated, according to US Food and Drug Administration (FDA) device labeling and the product labeling from each manufacturer, in patients with pacemakers, implantable cardioverter-defibrillators (ICDs), and left ventricular assist devices (LVADs). These are all radiofrequency transmission devices, and the question is this: Is the contraindication valid in light of our present-day understanding of the literature? An article recently published in the Annals of Gastroenterology and Hepatology reports the results of a very provocative in vitro study that says no, it's not valid.
Let's back up for a second. Why would we need this technology in these patients? The use of pacemakers and defibrillators has grown considerably over the past 2 decades, and those of you who are involved in caring for hospitalized patients, particularly those in the congestive heart failure arena, know that LVADs are increasingly used as a bridge to transplant or as a destination device to improve quality of life and get patients out of the hospital.
We have noted coincidently that in patients with LVAD implantations, reports of gastrointestinal bleeding have increased, as have vascular ectasias in the small bowel. What do we do when these patients present with complex cardiac diseases and devices, such as defibrillators and pacemakers? Are we unable to use capsule endoscopies in patients who most need them?
Ever since the capsule endoscopy was introduced in 2000, the focus of this device has expanded. Initially, it was used for small-bowel imaging, and then to look for esophageal varices. More recent studies have looked at using capsule endoscopy for colonoscopy in colon evaluations.
Capsule Endoscopy and Cardiac Device Contraindication
Hello. I am Dr. David Johnson, Professor of Medicine, and Chief of Gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia.
Capsule endoscopy -- a radiofrequency transmission-based device -- is contraindicated, according to US Food and Drug Administration (FDA) device labeling and the product labeling from each manufacturer, in patients with pacemakers, implantable cardioverter-defibrillators (ICDs), and left ventricular assist devices (LVADs). These are all radiofrequency transmission devices, and the question is this: Is the contraindication valid in light of our present-day understanding of the literature? An article recently published in the Annals of Gastroenterology and Hepatology reports the results of a very provocative in vitro study that says no, it's not valid.
Let's back up for a second. Why would we need this technology in these patients? The use of pacemakers and defibrillators has grown considerably over the past 2 decades, and those of you who are involved in caring for hospitalized patients, particularly those in the congestive heart failure arena, know that LVADs are increasingly used as a bridge to transplant or as a destination device to improve quality of life and get patients out of the hospital.
We have noted coincidently that in patients with LVAD implantations, reports of gastrointestinal bleeding have increased, as have vascular ectasias in the small bowel. What do we do when these patients present with complex cardiac diseases and devices, such as defibrillators and pacemakers? Are we unable to use capsule endoscopies in patients who most need them?
Ever since the capsule endoscopy was introduced in 2000, the focus of this device has expanded. Initially, it was used for small-bowel imaging, and then to look for esophageal varices. More recent studies have looked at using capsule endoscopy for colonoscopy in colon evaluations.
