A Prospective Study Comparing Real Time Video Capsule Endoscopy to Standard Endoscopy in Patients with Suspected Upper Gastrointestinal Bleeding

Abstract

AIM:To determine the diagnostic yield, quality of risk stratification, and patient tolerability of real time video capsule endoscopy (RTVCE) as compared to standard upper endoscopy and official video capsule endoscopy (O-VCE) in patients presenting with UGIB.

METHODS: A total of 20 patients were evaluated during our trial period. An official interpretation of the VCE (O-VCE) was performed by an experienced endoscopist and documented before the end of the day. Overall cumulative findings and their clinical significance were evaluated using the RT-VCE and O-VCE interpretations as compared to gold standard EGD. The level of agreement in individual re-bleeding risk was compared using EGD versus VCE obtained Rockall scores. A questionnaire on patient tolerability and satisfaction was administered after both procedures were completed.

RESULTS: Prospective analysis revealed that EGD and RT-VCE identified both low acuity and high acuity lesion at statistically similar rates (79% vs. 68%, p=0.157, and 21% vs. 32%, p=0.157 respectively). There was high level of agreement between the post endoscopy Rockall scores obtained for RT-VCE, O-VCE and EGD (Spearman correlation coefficient of 0.97 and 0.86 respectively,p<0.0001). Real time capsule endoscopy was the self reported preferable diagnostic test of choice.

CONCLUSION: RT-VCE has similar lesion detection rates when compared to both standard EGD and O-VCE, and may serve as a risk stratification tool in patients who present with suspected UGIB, and are at high risk for cardiopulmonary complications from EGD.