Video Capsule Endoscopy in the ED

Video Capsule Endoscopy in the ED

Esophagoduodenoscopy is the current gold standard for stratifying risk in patients with gastrointestinal (GI) bleeding, a potentially life-threatening emergency. However, this procedure is performed almost exclusively by gastroenterologists on patients admitted to the hospital. Studies have shown that when esophagoduodenoscopy is performed in the ED, as many as 46% of patients with acute upper GI hemorrhages can be safely discharged home. Video capsule endoscopy is a recently developed device that may improve care for upper gastrointestinal bleeding. Potential advantages of the device include improved availability, avoidance of sedation, increased patient tolerance, and the ability to rule out active bleeding. Few studies, however, have examined the use of video capsule endoscopy by emergency physicians for suspected acute upper GI bleeding events. Taking a Deeper Look In a pilot study published in the Annals of Emergency Medicine, my colleagues and I examined 25 patients with suspected acute upper GI hemorrhage. We compared video capsule endoscopy interpretations of emergency physicians who received a brief training to detect fresh blood or coffee-ground blood. We also wanted to determine if video capsule endoscopy was well tolerated by ED patients and estimate the test characteristics of video capsule endoscopy compared with esophagoduodenoscopy. In our analysis, there was 92% agreement between gastroenterologists and emergency physicians on test results. Video capsule endoscopy was well tolerated by nearly all patients in the study (96%) and showed sensitivity and specificity rates of 88% and 64%, respectively, for the detection of fresh blood. Potential Cost Savings Video capsule endoscopy performed in the ED has the potential to safely allow many patients with GI bleeding to be discharged home for outpatient...

Resuming Blood Thinner Use After a GI Bleed

Among patients with a warfarin-associated index gastrointestinal (GI) bleeding event, the decision to not resume warfarin within 90 days appears to be associated with higher risks for thrombosis and mortality. A cohort study demonstrated that resuming warfarin did not significantly increase the risk for recurrent GI bleeding. Abstract: Archives of Internal Medicine, September 2012...