A randomized controlled trial comparing efficacy of early video capsule endoscopy with standard of care in the approach to nonhematemesis GI bleeding (with videos) - 19/12/18
Abstract |
Background and Aims |
Patients presenting with nonhematemesis GI bleeding (NHGIB) represent a diagnostic challenge for physicians. We performed a randomized controlled trial to assess the benefits of deployment of a video capsule soon after admission in the management of patients presenting with melena, hematochezia, or severe anemia compared with standard of care management.
Methods |
Patients admitted with NHGIB were randomized and placed into 1 of 2 study groups. In the experimental group, patients ingested a video capsule soon after admission to the hospital. These patients had further endoscopic workup based on the findings from the capsule. Patients in the control group underwent endoscopic evaluation (ie, upper endoscopy, capsule endoscopy, and/or colonoscopy) to identify the source of bleeding as directed by the attending gastroenterologist’s interpretation of their clinical presentation. The primary endpoint for this study was the rate of localization of bleeding during hospitalization.
Results |
Eighty-seven patients were included in this study: 45 randomized to the standard of care arm and 42 to the early capsule arm. A bleeding source was localized in 64.3% of the patients in the early capsule arm and in 31.1% of the patients in the standard of care arm (P < .01). The likelihood of endoscopic localization of bleeding over time was greater for patients receiving early capsule endoscopy compared with those in the standard of care arm (adjusted hazard ratio, 2.77; 95% confidence interval, 1.36-5.64).
Conclusions |
For patients admitted to the hospital for NHGIB, early capsule endoscopy is a safe and effective alternative for the detection of the source of bleeding. (Clinical trial registration number: NCT02442830.)
Le texte complet de cet article est disponible en PDF.Abbreviations : CI, HR, NHGIB, OR, SRH, VCE
Plan
| DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: K. Bhattacharya: Clinical trial investigator for Olympus Corporation. D. R. Cave: Consultant for Boston Scientific; clinical trial investigator for Medtronic, Celgene, and Pfizer. All other authors disclosed no financial relationships relevant to this publication. Research support for this study was provided to D. R. Cave by Olympus Corporation. |
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| If you would like to chat with an author of this article, you may contact Dr Marya at nmarya@mednet.ucla.edu. |
Vol 89 - N° 1
P. 33 - janvier 2019 Retour au numéro
Article précédent
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- Early detection of GI bleeding: “starting the clock for the capsule drop”
- Richard M. Wu, Laurel R. Fisher
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