Risk Stratification Of Upper GI Bleeding Patients In the Emergency Room With “Real Time” Capsule Endoscopy – A Pilot Study
M. Rubin, MD; S. Hussain, MD; R. Cortes, MD; A. Shalomov, MD; N. Brodsky, MD; K. Somnay, MD; S. Kim, MD.
Background: Simple and accurate identification of stigmata of hemorrhage in emergency room (ER) patients with suspected acute upper GI bleeding (UGIB) with Real Time (Live) capsule endoscopy (CE) may facilitate proper triage and early therapeutic endoscopy. Historically, triage of these patients was based on the assessment of clinical parameters with or without the placement of a nasogastric tube (NGT).
Objective: In a pilot study we evaluated the feasibility, capability and accuracy of live view Pillcam Eso in patients with UGIB.
Methods: 20 patients (10 male, 10 female, mean age 65) with a history UGIB within 48 hours of admission to the ER were randomized to undergo live CE vs. standard clinical assessment. All patients were studied within 5 hours of arrival to the ER. Intravenous Metoclopromide was administered within 10 minutes of CE ingestion. CE was read real-time at the bedside and reviewed after download. Positive CE findings included coffee grounds, blood clot, red blood, or a bleeding lesion. Patients with positive live view CE findings underwent EGD within 6 hrs. Control patients and CE patients without bleeding underwent EGD within 24 hrs.
Results: 7/10 CE patients had positive findings. All 7 had stigmata of hemorrhage on endoscopy and underwent therapeutic intervention. 4/10 control patients had stigmata and therapeutic intervention. In 5/10 CE patients the actual lesion was identified on CE and confirmed at EGD. 3/10 study patients had a negative CE, 2 had no stigmata at EGD and 1 was not endoscoped due to co-morbidities. Time to endoscopy was 5.31 hours shorter in the study group. One capsule was retained in a strictured, ulcerated esophagus and was retrieved. There was no mortality. Blood transfusion requirement and length of stay were not significantly different in the 2 groups.
Conclusion: “Real Time” CE accurately identified high-risk ER patients with UGIB and facilitated appropriate triage. Use of CE could obviate the need for NGT passage and standardize the assessment of patients with UGIB. However, further study with a larger cohort will be required to validate these findings and assess outcomes data.