Risk stratification of upper GI bleeding with an esophageal capsule

BackgroundAnalysis of upper GI bleeding (UGIB) presentations to our institutions suggests that many patients admitted for endoscopic investigation could be managed safely as outpatients.ObjectiveTo learn whether an esophageal capsule could identify a low-risk group of patients with UGIB who could safely wait for elective EGD.DesignDiagnostic, nonrandomized, single-blind (investigator) study.SettingThree tertiary-care referral centers.PatientsEighty-three consecutive adult patients referred for management of UGIB.InterventionA capsule endoscopy (CE) was performed before EGD for the investigation and management of UGIB.Main Outcome MeasurementsDetection 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.ResultsIn 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.LimitationsLow duodenal visualization rates with CE and low concordance between EGD and CE.ConclusionAlthough 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. (Clinical trial registration number: ACTRN 12609000580279.)