Timing of video capsule endoscopy relative to overt obscure GI bleeding: implications from a retrospective study
Department of Medicine, Division of Gastroenterology; Department of Quantitative Health Sciences
Medical Subject Headings
Aged; Aged, 80 and over; Ambulatory Care; Capsule Endoscopy; Female; Gastrointestinal Hemorrhage; Hospitalization; Humans; Length of Stay; Male; Middle Aged; Retrospective Studies; Time Factors; Vascular Malformations
Digestive System Diseases | Gastroenterology
BACKGROUND: Diagnostic yield of video capsule endoscopy (VCE) may be higher if it is performed closer to the time of overt obscure GI bleeding (OOGIB).
OBJECTIVE: To evaluate the diagnostic yield of VCE and rate of therapeutic intervention for OOGIB for inpatients and outpatients with respect to timing of the intervention.
DESIGN: Retrospective cohort study.
SETTING: Tertiary academic center.
PATIENTS: Patients who had VCE for OOGIB between August 2008 and August 2010.
INTERVENTIONS: VCE for inpatients versus outpatients.
MAIN OUTCOME MEASURES: Diagnostic yield and rate of therapeutic intervention for inpatients versus outpatients.
RESULTS: One hundred forty-four inpatients (65 women) and 116 outpatients (49 women) were included. Diagnostic yield was 65.9% for inpatients versus 53.4% for outpatients (P = .054). Inpatients were divided into those who had VCE within 3 days (<3 >days; n = 90) of admission versus after 3 days (>3 days; n = 54). Active bleeding and/or an angioectasia was found in 44.4% of the3-day group (P = .046) versus 25.8% of the outpatients. Therapeutic intervention was performed in 18.9% of the3-day group (P = .046) versus 10.3% of outpatients. Diagnostic yield and therapeutic intervention rate between the >3-day group and outpatients were not significantly different. Length of stay (days) was less in the3-day cohort (P < .0001).
LIMITATIONS: Long-term outcomes were not studied. This was a retrospective study.
CONCLUSIONS: Early deployment of VCE within 3 days of admission results in a higher diagnostic yield and therapeutic intervention rate and an associated reduction of length of stay.