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

David E. Fleischer¹  Yan Ma²  Jincong Q. Freeman²  Alexander T. Limkakeng Jr³  Zubair Malik⁴  Nina T. Gentile⁴  Marie L. Borum⁵  Nataly Montano Vargas⁵  Samuel J. Kallus⁵  Nicole C. Hall⁵  Andrew C. Meltzer⁵  Anita B. Kumar⁵ 

[1] Mayo Clinic College of Medicine Scottsdale Arizona USA;Milken Institute School of Public Health George Washington University Washington District of Columbia USA;School of Medicine Duke University Durham North Carolina USA;School of Medicine Temple University Philadelphia Pennsylvania USA;School of Medicine and Health Sciences George Washington University Washington District of Columbia USA;

关键词: emergency department;    hospital admission;    risk stratification;    upper GI bleed;    video capsule endoscopy;   

DOI  :  10.1002/emp2.12579

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown