Rapid Evaluation of the Upper GI Tract Using Real-Time Pillcam™ ESO in Emergency Room Patients with Acute UGI Bleeding

Abstract

Purpose: Acute upper gastrointestinal bleeding is a prevalent condition with significant morbidity and mortality. Historically, clinical assessment and objective scoring systems have been used in the Emergency Room (ER) to guide management. Actual visualization of the UGI tract occurred later at endoscopy. In a pilot study, we present a novel use of “Real Time” Pillcam™ ESO to rapidly evaluate and visualize the UGI tract in ER patients with suspected UGIB. Methods: 13 patients (8 male, 5 female, mean age 63) with a history UGIB within 48 hours of admission to the ER underwent live CE at the bedside. All patients were studied within 5 hours of arrival to the ER. Intravenous Metoclopramide was administered within 10 minutes of CE ingestion. CE was read real-time at the bedside in the ER and reviewed for accuracy after download. Positive CE findings were defined as a bleeding lesion, signs of hemorrhage (coffee grounds, blood clot, red blood) or a non-bleeding lesion. Patients with a bleeding lesion or signs of hemorrhage underwent emergent EGD within 6 hrs. Results: 9/13 patients had positive findings on live view CE. In 3/9, the bleeding lesion was visualized and confirmed at EGD. In 5/9, signs of hemorrhage were seen on CE and subsequent EGD confirmed lesions with stigmata of hemorrhage. In 1/9, a non-bleeding lesion was visualized and confirmed at EGD. Formal review after download led to improved accuracy with 2 additional identifiable lesions (1 bleeding and 1 non-bleeding). Of the 4/13 patients with negative CE studies, three had EGD findings without stigmata of hemorrhage and one patient could not undergo endoscopy secondary to co-morbidities. In 6/13 patients the capsule did not reach the duodenum. However, 5/6 of these patients had a positive study with either bleeding lesions or signs of hemorrhage. One capsule was retained in a strictured, ulcerated esophagus and retrieved. All patients with stigmata of hemorrhage at EGD had positive findings at CE (either a bleeding lesion or signs of hemorrhage). Conclusion: “Real Time” CE in the ER is a safe and accurate tool in the evaluation of patients with UGIB. Use of CE in the ER enables rapid assessment of bleeding in the UGI tract. Further studies with a larger cohort will be required to validate these findings. Disclosure: Dr Moshe Rubin, has served as a Consultant for Given Imaging.