Timing of video capsule endoscopy relative to overt obscure GI bleeding: implications from a retrospective study

BackgroundDiagnostic yield of video capsule endoscopy (VCE) may be higher if it is performed closer to the time of overt obscure GI bleeding (OOGIB).ObjectiveTo evaluate the diagnostic yield of VCE and rate of therapeutic intervention for OOGIB for inpatients and outpatients with respect to timing of the intervention.DesignRetrospective cohort study.SettingTertiary academic center.PatientsPatients who had VCE for OOGIB between August 2008 and August 2010.InterventionsVCE for inpatients versus outpatients.Main Outcome MeasuresDiagnostic yield and rate of therapeutic intervention for inpatients versus outpatients.ResultsOne 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 the <3-day group compared with 27.8% of the >3-day group (P = .046) versus 25.8% of the outpatients. Therapeutic intervention was performed in 18.9% of the <3-day group versus 7.4% of the >3-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 the <3-day cohort, at 6.1 versus 10.3 in the >3-day cohort (P < .0001).LimitationsLong-term outcomes were not studied. This was a retrospective study.ConclusionsEarly 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.