WASHINGTON (Feb. 13, 2013 – Video capsule endoscopy performed in the emergency department to detect acute upper gastrointestinal bleeding, a potentially life-threatening emergency, may safely allow many patients with gastrointestinal hemorrhage to be discharged home instead of admitted to the hospital, saving the healthcare system billions of dollars.
The study, published online Friday in Annals of Emergency Medicine, is the first to examine the use of capsule endoscopy by emergency physicians for suspected acute upper gastrointestinal bleed ("Video Capsule Endoscopy in the Emergency Department: A Prospective Study of Acute Upper Gastrointestinal Hemorrhage").
"Video capsule endoscopy performed by emergency physicians was very accurate and nearly universally tolerated by patients," said lead study author Andrew Meltzer, MD, of George Washington University in Washington, D.C. "This is an example of the 'whiz-bang' side of emergency medicine that has the potential to save the health care system a great deal of money by preventing the hospital admissions that are typically required for esophagoduodenoscopy, a procedure used to diagnose acute bleeding."
Dr. Meltzer and his team enrolled 25 patients with suspected acute upper gastrointestinal hemorrhage in their pilot study. There was 92 percent agreement between gastroenterologists and emergency physicians on test results. Capsule endoscopy was well tolerated by nearly all (96 percent) of patients and showed 88 percent sensitivity and 64 percent specificity for the detection of fresh blood.
The current gold standard of care for patients with acute upper gastrointestinal hemorrhage is emergency esophagoduodenoscopy performed almost exclusively by gastroenterologists on patients who are admitted to the hospital. However, when esophagoduodenoscopy is performed in the emergency department, as many as 46 percent of patients with acute upper gastrointestinal hemorrhages can be safely discharged.
In 2011, 236,000 patients received an esophagoduodenoscopy in the hospital with an average hospital stay of 4 days costing $23,549 per patient. By comparison, the national average Medicare fee for the video capsule endoscopy is $750 per patient.
"While expensive, the use of video capsule endoscopy in the ER may be cost-effective if it safely reduces hospital admissions or emergency esophagoduodenoscopies," said Dr. Meltzer. "Further study is warranted to determine how the use of this new technology compares to the current standard of care and how it may safely guide clinical decision-making."
