182 A Multi-Center Randomized Trial of Capsule Endoscopy to Reduce Admissions in Emergency Department Patients With Low Risk Upper Gastrointestinal Bleed

Abstract

In US emergency departments (EDs), the provider has limited ability to evaluate for common and serious conditions of the gastrointestinal (GI) mucosa such as a bleeding peptic ulcer. Despite the fact that many bleeding lesions are self-limited, the majority of these patients require emergency hospitalization for an upper endoscopy (EGD). Our objective is to determine if ED risk stratification with Video Capsule Endoscopy (VCE) reduces need for hospitalization for low-to-moderate risk patients with suspected upper GI bleeding. A prospective multi-center randomized control trial was designed to investigate the safety of ED risk stratification with VCE. Stable ED patients with suspected upper GI bleeding were randomized to one of two treatment arms: (1) an experimental arm which included VCE risk stratification and brief ED observation versus (2) a standard of care arm which included an admission for inpatient EGD. Patients were followed for 30 days for safety outcomes. 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 at day 7 and day 30 after index ED visit. ED risk stratification with VCE leads to fewer hospitalizations without an increase in adverse events.