Skip to main content

Risk stratification with video capsule endoscopy leads to fewer hospital admissions in emergency department patients with low-risk to moderate-risk upper gastrointestinal bleed: A multicenter clinical trial.

Publication ,  Journal Article
Meltzer, AC; Limkakeng, AT; Gentile, NT; Freeman, JQ; Hall, NC; Vargas, NM; Fleischer, DE; Malik, Z; Kallus, SJ; Borum, ML; Ma, Y; Kumar, AB
Published in: J Am Coll Emerg Physicians Open
October 2021

OBJECTIVE: In US emergency departments (EDs), the physician has limited ability to evaluate for common and serious conditions of the gastrointestinal (GI) mucosa such as a bleeding peptic ulcer. Although many bleeding lesions are self-limited, the majority of these patients require emergency hospitalization for upper endoscopy (EGD). We conducted a clinical trial to determine if ED risk stratification with video capsule endoscopy (VCE) reduces hospitalization rates for low-risk to moderate-risk patients with suspected upper GI bleeding. METHODS: We conducted a randomized controlled trial at 3 urban academic EDs. Inclusion criteria included signs of upper GI bleeding and a Glasgow Blatchford score <6. Patients were randomly assigned to 1 of the following 2 treatment arms: (1) an experimental arm that included VCE risk stratification and brief ED observation versus (2) a standard care arm that included admission for inpatient EGD. The primary outcome was hospital admission. Patients were followed for 7 and 30 days to assess for rebleeding events and revisits to the hospital. RESULTS: The trial was terminated early as a result of low accrual. The trial was also terminated early because of a need to repurpose all staff to respond to the coronavirus disease 2019 pandemic. A total of 24 patients were enrolled in the study. In the experimental group, 2/11 (18.2%) patients were admitted to the hospital, and in the standard of care group, 10/13 (76.9%) patients were admitted to the hospital (P = 0.012). There was no difference in safety on day 7 and day 30 after the index ED visit. CONCLUSIONS: VCE is a potential strategy to decrease admissions for upper GI bleeding, though further study with a larger cohort is required before this approach can be recommended.

Duke Scholars

Published In

J Am Coll Emerg Physicians Open

DOI

EISSN

2688-1152

Publication Date

October 2021

Volume

2

Issue

5

Start / End Page

e12579

Location

United States
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Meltzer, A. C., Limkakeng, A. T., Gentile, N. T., Freeman, J. Q., Hall, N. C., Vargas, N. M., … Kumar, A. B. (2021). Risk stratification with video capsule endoscopy leads to fewer hospital admissions in emergency department patients with low-risk to moderate-risk upper gastrointestinal bleed: A multicenter clinical trial. J Am Coll Emerg Physicians Open, 2(5), e12579. https://doi.org/10.1002/emp2.12579

Published In

J Am Coll Emerg Physicians Open

DOI

EISSN

2688-1152

Publication Date

October 2021

Volume

2

Issue

5

Start / End Page

e12579

Location

United States