Endoscopy 2013; 45(01): 12-19
DOI: 10.1055/s-0032-1325933
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Capsule endoscopy in acute upper gastrointestinal hemorrhage: a prospective cohort study

I. M. Gralnek
1   Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
,
J. Y. L. Ching
2   Department of Gastroenterology, Prince of Wales Hospital, Hong Kong, China
,
I. Maza
1   Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
,
J. C. Y. Wu
2   Department of Gastroenterology, Prince of Wales Hospital, Hong Kong, China
,
T. H. Rainer
3   Department of Emergency Medicine, Prince of Wales Hospital, Hong Kong, China
,
S. Israelit
4   Department of Emergency Medicine, Rambam Health Care Campus, Haifa, Israel
,
A. Klein
1   Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
,
F. K. L. Chan
2   Department of Gastroenterology, Prince of Wales Hospital, Hong Kong, China
,
H. Ephrath
5   Department of Clinical Affairs/Biostatistics, GIVEN Imaging, Yoqneam, Israel
,
R. Eliakim
6   Department of Gastroenterology, Sheba Medical Center at Tel HaShomer, Tel Aviv, Israel
,
R. Peled
5   Department of Clinical Affairs/Biostatistics, GIVEN Imaging, Yoqneam, Israel
,
J. J. Y. Sung
2   Department of Gastroenterology, Prince of Wales Hospital, Hong Kong, China
› Institutsangaben
Weitere Informationen

Publikationsverlauf

submitted25. März 2012

accepted after revision04. August 2012

Publikationsdatum:
19. Dezember 2012 (online)

Background and study aims: Capsule endoscopy may play a role in the evaluation of patients presenting with acute upper gastrointestinal hemorrhage in the emergency department.

Patients and methods: We evaluated adults with acute upper gastrointestinal hemorrhage presenting to the emergency departments of two academic centers. Patients ingested a wireless video capsule, which was followed immediately by a nasogastric tube aspiration and later by esophagogastroduodenoscopy (EGD). We compared capsule endoscopy with nasogastric tube aspiration for determination of the presence of blood, and with EGD for discrimination of the source of bleeding, identification of peptic/inflammatory lesions, safety, and patient satisfaction.

Results: The study enrolled 49 patients (32 men, 17 women; mean age 58.3 ± 19 years), but three patients did not complete the capsule endoscopy and five were intolerant of the nasogastric tube. Blood was detected in the upper gastrointestinal tract significantly more often by capsule endoscopy (15 /18 [83.3 %]) than by nasogastric tube aspiration (6 /18 [33.3 %]; P = 0.035). There was no significant difference in the identification of peptic/inflammatory lesions between capsule endoscopy (27 /40 [67.5 %]) and EGD (35 /40 [87.5 %]; P = 0.10, OR 0.39 95 %CI 0.11 – 1.15). Capsule endoscopy reached the duodenum in 45 /46 patients (98 %). One patient (2.2 %) had self-limited shortness of breath and one (2.2 %) had coughing on capsule ingestion.

Conclusions: In an emergency department setting, capsule endoscopy appears feasible and safe in people presenting with acute upper gastrointestinal hemorrhage. Capsule endoscopy identifies gross blood in the upper gastrointestinal tract, including the duodenum, significantly more often than nasogastric tube aspiration and identifies inflammatory lesions, as well as EGD. Capsule endoscopy may facilitate patient triage and earlier endoscopy, but should not be considered a substitute for EGD.

 
  • References

  • 1 Gralnek IM, Barkun AN, Bardou M. Management of acute bleeding from a peptic ulcer. N Engl J Med 2008; 359: 928-937
  • 2 Barkun AN, Bardou M, Kuipers EJ et al. International consensus recommendations on the management of patients with non-variceal upper gastrointestinal bleeding. Ann Intern Med 2010; 152: 101-113
  • 3 Adam V, Barkun AN. Estimates of costs of hospital stay for variceal and non variceal upper gastrointestinal bleeding in the United States. Value in Health 2008; 11: 1-3
  • 4 Non-variceal upper gastrointestinal haemorrhage: guidelines. Gut 2002; 51: 1-6
  • 5 Adler DG, Leighton JA, Davila RE et al. ASGE guideline: The role of endoscopy in acute non-variceal upper-GI hemorrhage. Gastrointest Endosc 2004; 60: 497-504
  • 6 Mishkin DS, Chuttani R, Croffie J et al. ASGE Technology Status Evaluation Report: wireless capsule endoscopy. Gastrointest Endosc 2006; 63: 539-545
  • 7 Mergener K, Ponchon T, Gralnek IM et al. Literature review and recommendations for clinical application of small-bowel capsule endoscopy, based on a panel discussion by international experts. Consensus statements for small-bowel capsule endoscopy, 2006/2007. Endoscopy 2007; 39: 895-909
  • 8 Gralnek IM, Adler S, Yassin K et al. Detecting esophageal disease with second generation capsule endoscopy: initial evaluation of the PillCam® ESO-2. Endoscopy 2008; 40: 275-279
  • 9 Van Gossum A, Munoz-Navas M, Fernandez-Urien I et al. Capsule endoscopy versus colonoscopy for the detection of polyps and cancer. N Engl J Med 2009; 361: 264-270
  • 10 Rubin M, Hussain SA, Shalomov A et al. Live view video capsule endoscopy enables risk stratification of patients with acute upper GI bleeding in the emergency room: a pilot study. Dig Dis Sci 2011; 56: 786-791
  • 11 Gralnek I, Rabinovitz R, Afik D et al. A simplified ingestion procedure for esophageal capsule endoscopy: initial evaluation in healthy volunteers. Endoscopy 2006; 38: 913-918
  • 12 Barkun AN, Bardou M, Martel M et al. Prokinetics in acute upper GI bleeding: a meta-analysis. Gastrointest Endosc 2010; 72: 1138-1145
  • 13 Aljebreen AM, Fallone CA, Barkun AN. Nasogastric aspirate predicts high-risk endoscopic lesions in patients with acute upper-GI bleeding. Gastrointest Endosc 2004; 59: 172-178
  • 14 Esrailian E, Gralnek IM, Jensen D et al. Evaluating the process of care in nonvariceal upper gastrointestinal haemorrhage: a survey of expert vs. non-expert gastroenterologists. Aliment Pharmacol Ther 2008; 28: 1199-1208
  • 15 Huang ES, Karsan S, Kanwal F et al. Impact of nasogastric lavage on outcomes in acute GI bleeding. Gastrointest Endosc 2011; 74: 971-980
  • 16 Rockall TA, Logan RF, Devlin HB et al. Selection of patients for early discharge or outpatient care after acute upper gastrointestinal haemorrhage. National Audit of Acute Upper Gastrointestinal Haemorrhage. Lancet 1996; 347: 1138-1140
  • 17 Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet 2000; 356: 1318-1321
  • 18 Gralnek IM. Outpatient management of "low-risk" nonvariceal upper GI hemorrhage. Are we ready to put evidence into practice?. Gastrointest Endosc 2002; 55: 131-134
  • 19 Stanley AJ, Ashley D, Dalton HR et al. Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation. Lancet 2009; 373: 42-47