Risk stratification of upper GI bleeding with an esophageal capsule

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

doi:10.1016/j.gie.2013.01.003

Cited by 23 publications

(11 citation statements)

References 22 publications

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“…Therefore, early use of inpatient CE was useful in guiding the choice of the next most appropriate route of investigation or management, as well as aiding the decision whether to proceed with these investigations and interventions urgently or following discharge. Similarly, in previous studies where CE was used acutely or semi-acutely to investigate gastrointestinal bleeding ( Table 4 ), CE findings showed good correlation with subsequent UGIE where CE was performed as a first-line investigation before any other endoscopies 10 11 12 13 14 ; CE carried out after endoscopic imaging was effective in directing the subsequent route of investigation 15 16 17 18 19 20 21 .…”

Section: Discussionsupporting

confidence: 68%

Earlier use of capsule endoscopy in inpatients with melena or severe iron deficiency anemia reduces need for colonoscopy and shortens hospital stay

et al. 2018

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Background and study aims Capsule endoscopy(CE) is a well-established investigation for iron deficiency anemia (IDA) and melena, usually following negative upper and lower endoscopy. We aimed to study the effect of earlier CE in the investigative pathway for inpatients with IDA or melena at a large tertiary referral centre. Patients and methods We analyzed inpatients undergoing CE for IDA or melena from 2005 to 2017, without signs/symptoms suggesting lower gastrointestinal tract pathology. Patients underwent CE following negative upper and lower gastrointestinal endoscopy (Group 1), or negative upper gastrointestinal endoscopy (UGIE) only (Group 2). Results One hundred and seventy inpatients underwent CE for IDA (n = 44) and melena (n = 126). In Group 1, 46/95 (48.4%) patients had small bowel (SB) findings. CE found 16/95 (16.8 %) gastric and 12/95 (12.6 %) colon findings. Three of 12 patients with colon findings required repeat colonoscopy. One hundred and three colon investigations were carried out for 95 admissions. In Group 2, 33/75 (44.0%) patients had SB findings. There were 12/75 (16.0 %) gastric and 11/75 (14.7 %) colon findings. In patients with positive CE, significant colonic findings led to colonoscopy in 10 of 39 patients (diagnostic yield 6/10). Thirty-six patients had negative CE; 15 underwent colonoscopy (diagnostic yield 9/15). The remaining 21 of 36 patients with no further colonoscopy did not develop adverse outcomes related to colonic pathology. Twenty-six colon investigations were carried out in 75 admissions. Patients in Group 2 had shorter mean times from admission to CE (5.08 ± 3.80 vs. 6.38 ± 3.80 days; P = 0.02) and hospital stays (10.5 ± 9.58 vs. 12.5 ± 11.4 days; P = 0.04) compared to Group 1. Conclusion Earlier use of CE in inpatients with melena or IDA, no signs of lower gastrointestinal pathology and negative UGIE resulted in shortened hospital stays, significant DY from both small bowel and upper gastrointestinal tract, and two-thirds less unnecessary colon investigations without affecting clinical outcomes.

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Section: Discussionsupporting

confidence: 68%

Earlier use of capsule endoscopy in inpatients with melena or severe iron deficiency anemia reduces need for colonoscopy and shortens hospital stay

et al. 2018

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“…In a risk stratification study of UGIB from Australia, authors found that because of low duodenal visualisation, there was poor concordance between VCE and conventional endoscopy in the findings of the bleeding source in patients with UGIB. 93 …”

Section: Consensus Statementsmentioning

confidence: 99%

Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018

Sung

Chiu

Chan

et al. 2018

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225

210

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Non-variceal upper gastrointestinal bleeding remains an important emergency condition, leading to significant morbidity and mortality. As endoscopic therapy is the ’gold standard' of management, treatment of these patients can be considered in three stages: pre-endoscopic treatment, endoscopic haemostasis and post-endoscopic management. Since publication of the Asia-Pacific consensus on non-variceal upper gastrointestinal bleeding (NVUGIB) 7 years ago, there have been significant advancements in the clinical management of patients in all three stages. These include pre-endoscopy risk stratification scores, blood and platelet transfusion, use of proton pump inhibitors; during endoscopy new haemostasis techniques (haemostatic powder spray and over-the-scope clips); and post-endoscopy management by second-look endoscopy and medication strategies. Emerging techniques, including capsule endoscopy and Doppler endoscopic probe in assessing adequacy of endoscopic therapy, and the pre-emptive use of angiographic embolisation, are attracting new attention. An emerging problem is the increasing use of dual antiplatelet agents and direct oral anticoagulants in patients with cardiac and cerebrovascular diseases. Guidelines on the discontinuation and then resumption of these agents in patients presenting with NVUGIB are very much needed. The Asia-Pacific Working Group examined recent evidence and recommends practical management guidelines in this updated consensus statement.

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“…CE detected dyspeptic/inflammatory lesions comparable to OGD in one study [19], while a further reported 88 % sensitivity and 65 % specificity for CE ability to detect fresh blood in the upper GI tract. 25 % of patients with normal OGD in this study had a positive CE suggesting lesions can be overlooked with both techniques [20]. CE appears to be at least as accurate as our traditional scoring systems for upper GI bleeding; however, larger studies are needed to confirm these findings [21].…”

Section: Upper Gi Bleedingmentioning

confidence: 66%

“…ED physicians appeared to be competent to use the system after a brief training period [22]. Initial cost analyses appear favourable although further studies are required to validate this [20].…”

Section: Upper Gi Bleedingmentioning

confidence: 91%