630 Inpatient Capsule Endoscopy Does Not Lead to Increased Hospital Interventions in Stable Small Bowel Bleeding

Abstract

INTRODUCTION: Wireless capsule endoscopy is an important tool to evaluate for small bowel sources of bleeding when upper and lower endoscopies have been unrevealing. However its use as an inpatient test is controversial with some studies suggesting increased capsule retention, prolonged length of stay, and increased costs. We aimed to assess the yield of inpatient capsule endoscopy when hemoglobin stability or resolution of overt bleeding is achieved prior to capsule deployment. METHODS: We performed a retrospective study of 161 patients with suspected small bowel bleeding over a 3 year period. Primary outcome was inpatient endoscopic interventions in patients with positive capsule findings but stable precapsule hemoglobin or resolved overt bleeding. Other outcomes included length of stay, success of intervention, outpatient follow-up, rehospitalization, and capsule complications. RESULTS: A total of 119 of the 161 patients (79.9%) had positive capsule findings. Only 70 patients underwent subsequent endoscopic intervention prior to discharge. Even in patients with active bleeding seen, 15% were discharged without endoscopic intervention. Hemoglobin stability and resolution of overt bleeding prior to capsule deployment were found to be significant predictors of whether patients underwent intervention. Those who had a stable hemoglobin for 8, 24, and up to 48 hours prior to capsule deployment had significantly less endoscopic interventions prior to discharge (P = 0.0026). Additionally, patients with a stable precapsule hemoglobin had a significantly decreased chance of having an identified lesion with successful treatment on enteroscopy (P = 0.0097). Those who had resolution of overt bleeding prior to capsule deployment also had significantly less endoscopic interventions prior to discharge (P = 0.0036). However, those with a stable hemoglobin with positive capsule findings had higher rehospitalization rates with only 14% having follow-up outpatient enteroscopies. Overall capsule retention rate was 19%. Capsules extended length of stay by an average of 1.7 days with 45% of patients discharged within 48 hours of capsule read. CONCLUSION: Inpatient capsule endoscopy extends length of stay with high retention rates without changing in-hospital endoscopic management of patients with small bowel bleeding who have achieved hemoglobin stability and resolution of overt bleeding prior to capsule deployment. These patients however tend to have higher rehospitalization rates and require close outpatient follow-up.