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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
Meltzer, Andrew C. Limkakeng Jr., Alexander T. Freeman, Jincong Q. Hall, Nicole C. Montano Vargas, Nataly Fleischer, David E. Kallus, Samuel J. Borum, Marie L.
Meltzer, Andrew C.
Limkakeng Jr., Alexander T.
Freeman, Jincong Q.
Hall, Nicole C.
Montano Vargas, Nataly
Fleischer, David E.
Kallus, Samuel J.
Borum, Marie L.
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2021-10-25
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https://doi.org/10.1002/emp2.12579
Abstract
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.
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Meltzer, AC, Limkakeng, AT, Gentile, NT, et al. 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. JACEP Open. 2021; 2:e12579. https://doi.org/10.1002/emp2.12579
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Wiley Open Access
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Journal of the American College of Emergency Physicians Open, Vol. 2
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