Risk stratification of upper GI bleeding with an esophageal capsule

Sujievvan Chandran, Adam G Testro, Paul Urquhart, Richard La Nauze, Sim Ong, Edward Shelton, Hamish Philpott, Siddarth Sood, Rhys Vaughan, William Kemp, Gregor Brown, Paul R A Froomes

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Abstract

Background: Analysis of upper GI bleeding (UGIB) presentations to our institutions suggests that many patients admitted for endoscopic investigation could be managed safely as outpatients. Objective: To learn whether an esophageal capsule could identify a low-risk group of patients with UGIB who could safely wait for elective EGD. Design: Diagnostic, nonrandomized, single-blind (investigator) study. Setting: Three tertiary-care referral centers. Patients: Eighty-three consecutive adult patients referred for management of UGIB. Intervention: A capsule endoscopy (CE) was performed before EGD for the investigation and management of UGIB. Main Outcome Measurements: Detection rates of UGIB source and identification of a low-risk group of patients who would have been suitable for outpatient EGD based on CE findings. Results: In total, 62 of 83 patients (75%) had a cause for bleeding identified. Findings were concordant across both modalities in 34 patients (55%). Twenty-one patients (38%) with positive EGD results had negative CE results, 7 of whom were due to lack of duodenal visualization alone. However, 7 of 28 patients (25%) with normal EGD results had positive CE results. The subgroup of patients with duodenal visualization on CE, 23 of 25 (92%), were concordant with EGD for low-risk lesions that would have been suitable for outpatient management. Limitations: Low duodenal visualization rates with CE and low concordance between EGD and CE. Conclusion: Although CE is not currently ready to be used as a triage tool, when duodenal visualization was achieved CE correlated well with EGD findings and identified 92% of patients who may have been managed as outpatients.

Original languageEnglish
Pages (from-to)891-898
Number of pages8
JournalGastrointestinal Endoscopy
Volume77
Issue number6
DOIs
Publication statusPublished - Jun 2013
Externally publishedYes

Keywords

  • capsule endoscopy
  • CE
  • UGIB
  • upper GI bleeding

Cite this

Chandran, S., Testro, A. G., Urquhart, P., La Nauze, R., Ong, S., Shelton, E., Philpott, H., Sood, S., Vaughan, R., Kemp, W., Brown, G., & Froomes, P. R. A. (2013). Risk stratification of upper GI bleeding with an esophageal capsule. Gastrointestinal Endoscopy, 77(6), 891-898. https://doi.org/10.1016/j.gie.2013.01.003