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
Abstract 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...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-10-01
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| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.12579 |
| _version_ | 1797835969203798016 |
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| author | Andrew C. Meltzer Alexander T. Limkakeng Jr Nina T. Gentile Jincong Q. Freeman Nicole C. Hall Nataly Montano Vargas David E. Fleischer Zubair Malik Samuel J. Kallus Marie L. Borum Yan Ma Anita B. Kumar |
| author_facet | Andrew C. Meltzer Alexander T. Limkakeng Jr Nina T. Gentile Jincong Q. Freeman Nicole C. Hall Nataly Montano Vargas David E. Fleischer Zubair Malik Samuel J. Kallus Marie L. Borum Yan Ma Anita B. Kumar |
| author_sort | Andrew C. Meltzer |
| collection | DOAJ |
| description | Abstract 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. Conclusions VCE is a potential strategy to decrease admissions for upper GI bleeding, though further study with a larger cohort is required before this approach can be recommended. |
| first_indexed | 2024-04-09T15:01:05Z |
| format | Article |
| id | doaj.art-ba35819aa6c0411b85a9ba248234f152 |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2024-04-09T15:01:05Z |
| publishDate | 2021-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-ba35819aa6c0411b85a9ba248234f1522023-05-01T17:35:54ZengWileyJournal of the American College of Emergency Physicians Open2688-11522021-10-0125n/an/a10.1002/emp2.12579Risk 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 trialAndrew C. Meltzer0Alexander T. Limkakeng Jr1Nina T. Gentile2Jincong Q. Freeman3Nicole C. Hall4Nataly Montano Vargas5David E. Fleischer6Zubair Malik7Samuel J. Kallus8Marie L. Borum9Yan Ma10Anita B. Kumar11School of Medicine and Health Sciences George Washington University Washington District of Columbia USASchool of Medicine Duke University Durham North Carolina USASchool of Medicine Temple University Philadelphia Pennsylvania USAMilken Institute School of Public Health George Washington University Washington District of Columbia USASchool of Medicine and Health Sciences George Washington University Washington District of Columbia USASchool of Medicine and Health Sciences George Washington University Washington District of Columbia USAMayo Clinic College of Medicine Scottsdale Arizona USASchool of Medicine Temple University Philadelphia Pennsylvania USASchool of Medicine and Health Sciences George Washington University Washington District of Columbia USASchool of Medicine and Health Sciences George Washington University Washington District of Columbia USAMilken Institute School of Public Health George Washington University Washington District of Columbia USASchool of Medicine and Health Sciences George Washington University Washington District of Columbia USAAbstract 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. Conclusions VCE is a potential strategy to decrease admissions for upper GI bleeding, though further study with a larger cohort is required before this approach can be recommended.https://doi.org/10.1002/emp2.12579emergency departmenthospital admissionrisk stratificationupper GI bleedvideo capsule endoscopy |
| spellingShingle | Andrew C. Meltzer Alexander T. Limkakeng Jr Nina T. Gentile Jincong Q. Freeman Nicole C. Hall Nataly Montano Vargas David E. Fleischer Zubair Malik Samuel J. Kallus Marie L. Borum Yan Ma Anita B. Kumar 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 Journal of the American College of Emergency Physicians Open emergency department hospital admission risk stratification upper GI bleed video capsule endoscopy |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | emergency department hospital admission risk stratification upper GI bleed video capsule endoscopy |
| url | https://doi.org/10.1002/emp2.12579 |
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