Capsule endoscopy in acute upper gastrointestinal hemorrhage: a prospective cohort study

Gralnek, Ian M.; Ching, Jessica; Maza, Itay; Wu, Justin C. Y.; Rainer, Timothy Hudson; Israelit, Shlomo Hanan; Klein, Amir; Chan, Francis K.L.; Ephrath, Hagit; Eliakim, Rami; Peled, Ravit; Sung, Joseph J.Y.

doi:10.1055/s-0032-1325933

Cited by 31 publications

(28 citation statements)

References 11 publications

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“…It has shown potential to identify high and low-risk patients presenting with signs of AUGIB, helping to determine the need for intervention with significant reduction in the time to emergent endoscopic therapy 61. VCE in the ED is safe and effective in identifying AUGIB 62. A study by Meltzer et al looked into the use of VCE in the ED performed by a gastroenterologist or a VCE-trained clinician.…”

Section: What Are the Future Developments?mentioning

confidence: 99%

Management of non-variceal upper gastrointestinal bleeding: where are we in 2018?

Alzoubaidi

Lovat

Haidry

2018

Frontline Gastroenterol

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Acute upper gastrointestinal bleeding (AUGIB) is one of the most common medical emergencies in the UK. Despite advancement in technology the management of AUGIB remains a challenge. The clinical community recognise the need for improvement in the treatment of these patients. AUGIB has a significant impact on resources. Endoscopic therapy is the gold standard treatment. The mortality in AUGIB is rarely related to the presenting bleed but significantly associated with concurrent comorbidities. The cost of blood transfusion in the management of patients with AUGIB is significant and misuse of blood products has been documented nationally. Risk stratification tools such as Glasgow-Blatchford Score, Rockall Score and the AIMS65 score have allowed clinicians to triage patients appropriately in order to deliver endoscopic therapy within a suitable time frame. Endoscopic therapeutic modalities such as epinephrine injection, heat thermocoagulation and mechanical clips have had a positive impact on patient’s management. However, in order to continue to improve patient’s outcomes, further developments are needed.

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Section: What Are the Future Developments?mentioning

confidence: 99%

Management of non-variceal upper gastrointestinal bleeding: where are we in 2018?

Alzoubaidi

Lovat

Haidry

2018

Frontline Gastroenterol

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“…5,6 Video capsule enteroscopy (VCE) has been proven safe for use in this patient population, but its effectiveness and timing has never been fully evaluated. 7 With recent studies by Meltzer et al 8 and Gralnek et al 9 documenting the utility and cost-effectiveness of early VCE in the emergency room setting, earlier utilization of this technology is now on the rise. The aim of this study is to examine diagnostic yield and overall effectiveness of VCE in the evaluation of obscure gastrointestinal bleeding (OGIB) in patients implanted with a LVAD.…”

Section: Abstract: Video Capsule Enteroscopy (Vce) Capsule Endoscopmentioning

confidence: 99%

Early Implementation of Video Capsule Enteroscopy in Patients with Left Ventricular Assist Devices and Obscure Gastrointestinal Bleeding

et al. 2016

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Gastrointestinal bleeding (GIB) is a frequent challenge encountered in patients implanted with a left ventricular assist device (LVAD), affecting approximately 25% of this population. Many patients have no identifiable source of bleeding after routine esophagogastroduodenoscopy and colonoscopy and are labeled as obscure GIB (OGIB). Significant costs and invasive procedures are required to investigate and stop the source of bleeding in these patients. We performed a retrospective analysis at a single tertiary referral center to investigate the diagnostic yield and overall effectiveness of video capsule enteroscopy (VCE) in this population. Eight patients with LVADs underwent nine VCE studies for OGIB. The diagnostic yield was 100%, with intraluminal blood the most common finding. The jejunum was the most common location for pathology detected on VCE. Sixty-seven percent of the studies directly guided further endoscopy with successful cessation of bleeding in 100% of these patients. Finally, after an average follow-up of 46 weeks, the total number of endoscopic procedures and total units of transfused packed red blood cells (pRBC) were significantly less after the patient underwent the VCE study compared with before. Video capsule enteroscopy is a safe and high-yield investigative procedure in this population and should be implemented earlier to improve patient outcomes and reduce costs of care.

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“…Prior studies have shown that if an EGD is performed in the ED, between 30 and 46% of ED patients with upper GI tract hemorrhage can be safely discharged . Previous studies have shown that the VCE is well tolerated in the ED and has similar test characteristics to traditional endoscopy …”

Section: Discussionmentioning

confidence: 99%

“…There is a need for a new paradigm of risk stratification that can occur in the ED and without a gastroenterologist needing to be present at the bedside. The use of video capsule endoscopy (VCE) may represent such a new diagnostic paradigm for ED patients with acute upper GI hemorrhage . The potential advantages of VCE include the ability to be performed 24 hours a day, to be performed without conscious sedation, to be administered by any operator, to be well tolerated by patients, and to provide actionable results at the point of care .…”

mentioning

confidence: 99%

Emergency Physicians Accurately Interpret Video Capsule Endoscopy Findings in Suspected Upper Gastrointestinal Hemorrhage: A Video Survey

et al. 2013

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Background: Acute upper gastrointestinal (GI) hemorrhage is a common emergency department (ED) presentation whose severity ranges from benign to life-threatening and the best tool to risk stratify the disease is an upper endoscopy, either by scope or by capsule, a procedure performed almost exclusively by gastroenterologists. Unfortunately, on-call gastroenterology specialists are often unavailable, and emergency physicians (EPs) currently lack an alternative method to endoscopically visualize a suspected acute upper GI hemorrhage. Recent reports have shown that video capsule endoscopy is well tolerated by ED patients and has similar sensitivity and specificity to endoscopy for upper GI hemorrhage.

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Capsule endoscopy in acute upper gastrointestinal hemorrhage: a prospective cohort study

Cited by 31 publications

References 11 publications

Management of non-variceal upper gastrointestinal bleeding: where are we in 2018?

Management of non-variceal upper gastrointestinal bleeding: where are we in 2018?

Early Implementation of Video Capsule Enteroscopy in Patients with Left Ventricular Assist Devices and Obscure Gastrointestinal Bleeding

Emergency Physicians Accurately Interpret Video Capsule Endoscopy Findings in Suspected Upper Gastrointestinal Hemorrhage: A Video Survey

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