Inpatient Versus Outpatient Capsule Evaluation of Overt Obscure Acute GI Bleed

Abstract

Introduction: Obscure GI bleed (OGIB) constitute 5% of all acute GI bleed. Capsule endoscopy is recommended as the first line diagnostic study after a negative panendoscopy.Table 1: Comparison of Inpatient and Outpatient CohortsMethods: This is a Retrospective Cohort Study comparing inpatient and outpatient capsule endoscopy done for the evaluation of acute overt OGIB in patients admitted to a single center. 438 charts from 2009 to 2014 were reviewed with 121 patients identified as Acute OGIB. 76 had inpatients and 44 had outpatient capsules and were included in the final analysis after excluding 5 inpatient and 4 outpatients for being incomplete. Lesions were sorted into P0, P1 and P2 based on classification used by Saurin et al. Active bleed was a separate category. Patients' characteristics were compared. Both cohorts were combined and regrouped into positive lesion/active bleed and negative lesion/active bleed. Regression analysis was used to identify predictors of high probability of finding a positive lesion/active bleed. Results: There was no statistically significant difference in the characteristics of both cohorts including positive lesions and active bleed. There was shorter length of stay for the outpatient group of 4days compared to outpatient of 6.3 days(p-value < .001) with means difference of 2.3 days. 30% of these inpatient studies were done within 24hours of discharge. The inpatient cohorts had mean study time of 4.3days from admission compared to 17days for the outpatient cohort(p-value < .001). Subgroup analysis for inpatient studies was done.Odd ratio of finding a positive lesion and or active bleed when studies was done < 3days was not significant. Mean lenght of stay for Inpatient studies done by days 3 of the admission was 4.3days compared to 8.3days(p-value < .001) for studies done after day 3. Simultaneous Logistic regression showed no predictor of positive lesions and or active bleed. Bonferronni correction was done for all Family-wise alpha values. Conclusion: The inpatient cohorts had significantly longer stay in the hospital compared to outpatient cohort. However, subgroup analysis showed studies done within 3days of admission had length of stay that is not statistically different from the outpatient cohort. Since timing of the study did not affect diagnostic yield, stable patient who are unable to get capsule done within 3days of admission could be scheduled for outpatient study. With 30% of the inpatient studies being done within 24hours of discharge this will decrease the overall length of stay.