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

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Background

Diagnostic yield of video capsule endoscopy (VCE) may be higher if it is performed closer to the time of overt obscure GI bleeding (OOGIB).

Objective

To evaluate the diagnostic yield of VCE and rate of therapeutic intervention for OOGIB for inpatients and outpatients with respect to timing of the intervention.

Setting

Tertiary academic center.

Patients

Patients who had VCE for OOGIB between August 2008 and August 2010.

Interventions

VCE for inpatients versus outpatients.

Main Outcome Measures

Diagnostic yield and rate of therapeutic intervention for inpatients versus outpatients.

Results

One 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).

Limitations

Long-term outcomes were not studied. This was a retrospective study.

Conclusions

Early 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.

Section snippets

Methods

Our center is a large referral facility for central and western Massachusetts. Five hundred and seven VCEs were performed over a 2-year period from August 2008 to August 2010. Two hundred sixty VCEs were done to evaluate OOGIB and were included in the study. Specifically, we excluded patients with occult OGIB or iron deficiency anemia from the evaluation. We had a large cohort of patients with OOGIB for both the inpatient (n = 144) and outpatient (n = 116) populations, which is a much larger

Results

The study design, including distribution of the patients, is showed in Figure 1, and patient demographics are presented in Table 1.

A positive result was defined as active bleeding, angioectasia, red spot, tumor, ulcer, or bleeding outside of the small intestine (stomach or colon). The overall yield of VCE was 65.9% (95 of 144) for the inpatient population versus 53.4% (62 of 116) for the outpatient population (P = .054). Red spots were included in the list of positive findings but were not

Discussion

In this retrospective analysis of the use of VCE performed for OOGIB in both inpatients and outpatients, we demonstrated that the early deployment of VCE results in a higher diagnostic yield and increased rate of therapeutic intervention. In turn, early deployment was associated with a significant reduction in length of stay, possibly associated with the increased intervention rate and reduction of the numbers of other procedures.

Statistically, the overall diagnostic yield of VCE was not

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DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: S D Person was partially supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award numbers UL1RR031982 and UL1TR000161. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health. Otherwise this was an investigator-initiated study with no external funding. K Bhattacharya: research consultant in deep enteroscopy for Olympus Corp. D R Cave: research support consultant in video capsule endoscopy for Olympus Corp.; research support for Capsovision. All other authors disclosed no financial relationships relevant to this publication.

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