Live View Video Capsule Endoscopy Enables Risk Stratification of Patients with Acute Upper GI Bleeding in the Emergency Room: A Pilot Study

Rubin, Moshe; Hussain, Syed A.; Shalomov, Albert; Cortes, Rafael; Smith, Michael S.; Kim, Sang Ho

doi:10.1007/s10620-010-1336-9

Cited by 44 publications

(32 citation statements)

References 18 publications

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“…In a recent study we demonstrated the ability of live view Pillcam ESO ® to identify UGIB patients with high-risk endoscopic stigmata [Rubin et al 2011]. The Blatchford and Rockall scores, were designed to predict the need for clinical intervention and mortality, respectively, and have been well described in the literature [Blatchford et al 2000;Rockall et al 1996;Stanley et al 2009;Vreeburg et al 1999;Chandra et al 2012;Romagnuolo et al 2007;Pang et al 2010;Le Jeune et al 2011;Chen et al 2007].…”

Section: Discussionmentioning

confidence: 99%

“…The pilot Pillcam ESO ® bleeding study was a prospective, randomized, controlled clinical trial that enrolled consecutive patients who presented with signs and symptoms of acute UGIB to an urban tertiary care academic hospital [Rubin et al 2011].The study protocol and informed consent were approved by the hospital's institutional review board.…”

Section: Methodsmentioning

confidence: 99%

“…The data recorder was attached by USB cable to a Fujitso mini-notebook computer running Rapid Viewer ® . Pillcam ESO 2 ® was administered in a standard fashion [Rubin et al 2011]. The entire exam was observed live by one of the investigators and reviewed after download by a second investigator.…”

Section: Methodsmentioning

confidence: 99%

“…In a prior study we found that rapid live bedside video capsule endoscopy (VCE) utilizing Pillcam ESO ® correctly identified patients with high-risk stigmata of bleeding confirmed on upper endoscopy [Rubin et al 2011]. In this study, we assess the predictive value of the Rockall and Blatchford scores compared with Pillcam ESO ® in predicting high-risk endoscopic stigmata.…”

Section: Introductionmentioning

confidence: 98%

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Pillcam ESO^® is more accurate than clinical scoring systems in risk stratifying emergency room patients with acute upper gastrointestinal bleeding

Gutkin

Shalomov

Hussain

et al. 2013

Therap Adv Gastroenterol

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Background: Upper gastrointestinal bleeding (UGIB) accounts for 400,000 hospital admissions in the US each year. Despite advances, mortality rates remain high and are estimated to be 5-10%. Early therapeutic endoscopy is widely recommended as a means of reducing morbidity and mortality. The Rockall and Blatchford scores are clinical scoring systems devised to assist in risk stratifying patients with UGIB. In a prior study we found that rapid live bedside video capsule endoscopy (VCE) utilizing Pillcam ESO ® correctly identified patients with high-risk stigmata of bleeding seen on upper endoscopy. In this study, we compare the accuracy of the Rockall and Blatchford scores with Pillcam ESO ® in predicting high-risk endoscopic stigmata. Methods: Pre-endoscopy Blatchford and Rockall scores were calculated for 25 patients (14 males, 11 females) presenting to the emergency room with acute UGIB. The average patient was 66 years of age. A total of 24 out of 25 patients underwent upper endoscopy within 24 hours. One patient did not undergo endoscopy due to clinical instability. The timing of endoscopy was based on clinical parameters in 12 patients, and on live view VCE with Pillcam ESO ® in the other 13 patients. Positive VCE was defined as red blood, clot or coffee grounds. Mean Rockall and Blatchford scores for all 24 patients were compared to determine potential differences between high-and low-risk patients. Rockall and Blatchford scores were also compared with VCE findings. Results: Of 24 patients, 13 had high-risk stigmata on upper endoscopy. The mean Rockall and Blatchford scores were 3 and 13, respectively. In the 11 patients without stigmata, the mean Rockall and Blatchford scores were 2 and 11, respectively. There was no statistically significant difference between the Blatchford scores of the two groups (95% confidence interval [CI] -5.1 to 1.3; p = 0.22). There was no statistically significant difference between the Rockall scores of the two groups (95% CI -2.3 to 0.3; p = 0.11). In the subgroup of 12 patients who underwent VCE prior to endoscopy, 8/12 had positive findings, which were all confirmed at endoscopy. All 4 patients with negative VCE had no high-risk stigmata at endoscopy. Conclusion:In emergency room patients with acute UGIB, neither the Rockall nor the Blatchford scores were able to differentiate high-and low-risk patients identified at endoscopy. Live view VCE, however, was accurate in predicting high-risk endoscopic stigmata, and may be better suited as a risk stratification tool. Additional studies with a larger cohort will be required to validate these findings.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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Pillcam ESO^® is more accurate than clinical scoring systems in risk stratifying emergency room patients with acute upper gastrointestinal bleeding

Gutkin

Shalomov

Hussain

et al. 2013

Therap Adv Gastroenterol

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“…A recent study has evaluated this in the emergency room in the setting of acute upper GI bleed with the PillcamEso. Live Viewing enabled the identification of high and low risk patients and was able to risk stratify the patients who needed EGD in under six hours versus twenty-four hours [102].…”

Section: Other Areas Of Interestmentioning

confidence: 99%

Video Capsule Endoscopy: The Past, Present, and Future

Whitmer¹

2013

J Gastrointest Dig Syst

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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

et al. 2021

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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.

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Live View Video Capsule Endoscopy Enables Risk Stratification of Patients with Acute Upper GI Bleeding in the Emergency Room: A Pilot Study

Abstract: Live view VCE accurately identifies high and low risk ER patients with UGIB. Use of VCE to risk stratify these patients significantly reduced time to emergent EGD and therapeutic intervention.

Cited by 44 publications

References 18 publications

Pillcam ESO^® is more accurate than clinical scoring systems in risk stratifying emergency room patients with acute upper gastrointestinal bleeding

Pillcam ESO^® is more accurate than clinical scoring systems in risk stratifying emergency room patients with acute upper gastrointestinal bleeding

Video Capsule Endoscopy: The Past, Present, and Future

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

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Live View Video Capsule Endoscopy Enables Risk Stratification of Patients with Acute Upper GI Bleeding in the Emergency Room: A Pilot Study

Abstract: Live view VCE accurately identifies high and low risk ER patients with UGIB. Use of VCE to risk stratify these patients significantly reduced time to emergent EGD and therapeutic intervention.

Cited by 44 publications

References 18 publications

Pillcam ESO® is more accurate than clinical scoring systems in risk stratifying emergency room patients with acute upper gastrointestinal bleeding

Pillcam ESO® is more accurate than clinical scoring systems in risk stratifying emergency room patients with acute upper gastrointestinal bleeding

Video Capsule Endoscopy: The Past, Present, and Future

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

Contact Info

Product

Resources

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Pillcam ESO^® is more accurate than clinical scoring systems in risk stratifying emergency room patients with acute upper gastrointestinal bleeding

Pillcam ESO^® is more accurate than clinical scoring systems in risk stratifying emergency room patients with acute upper gastrointestinal bleeding