Impact of Inpatient Status on Diagnostic Yield and Clinical Outcome of Video Capsule Endoscopy (VCE) in the Evaluation of Obscure Gastrointestinal Bleeding (OGIB)

Abstract

Introduction: VCE for the evaluation of OGIB is most commonly performed in the outpatient setting. We aimed to investigate the differences in demographics, clinical work-up, and capsule findings between inpatients and outpatients undergoing VCE for the evaluation of OGIB. Methods: Retrospective analysis of all patients undergoing VCE for the evaluation of OGIB at the University of Alabama, Birmingham between October 2008 and July 2012. We excluded studies with technical errors or retention. Average follow-up was 54 weeks. Relevant data was obtained through chart review and examined with chi-square, t test, and univariable analysis. Results: Three hundred-two (82%) VCE studies were performed for the indication of OGIB during the specified time period. Seventeen studies were excluded, leaving 285 studies for analysis. One hundred-six (37%) patients had the VCE performed as an inpatient, with 178 (63%) done as an outpatient (Table 1). Compared to outpatients, inpatients were more often black (p=0.015), on aspirin (p=0.008) or Coumadin (p=0.009), and presented with overt OGIB (p<0.0001). They received more RBC transfusions (p<0.0001) and underwent more endoscopic and radiologic studies prior to the VCE (p=0.001). Small bowel transit time (SBTT) was longer (p=0.01), and completion rates lower (p=0.0009) in inpatients. Significant findings (p=0.03) including intraluminal bleeding (p<0.0001) were more common in inpatients, while angioectasias were less common (p=0.05). Inpatients were more likely to undergo post-CE interventions compared to outpatients (p<0.0001).Table 1: Impact of Hospital StatusConclusion: When compared to outpatients, inpatients undergoing VCE are more often black, taking antiplatelet or anticoagulant drugs, present with overt bleeding, require more RBC transfusions, and undergo more investigational studies prior to the VCE. The diagnostic yield is higher in inpatients compared to outpatients. Given the extensive number of non-diagnostic tests performed prior to VCE and the higher diagnostic yield of VCE in inpatients, we suggest earlier implementation of VCE in inpatients presenting with the above characteristics.