Gastrointestinal hemorrhage: Preventing costly hospital admissions

January 12th, 2015

With thousands of gastrointestinal hemorrhage patients seen in the emergency department (ED) each year, a team of doctors from George Washington University decided to test the use of video capsule endoscopy on these patients.

Video capsule endoscopy is performed in the emergency department to detect acute gastrointestinal bleeding, which is a potentially life-threatening emergency. The current treatment for patients with acute gastrointestinal hemorrhage is emergency esophagoduodenoscopy, almost always performed by gastroenterologists on patients who have been admitted to the hospital.

Andrew Meltzer, MD, and his team enrolled 25 patients with suspected acute upper gastrointestinal hemorrhage in a first-of-its-kind pilot study. Of these patients, 96% tolerated capsule endoscopy well, with 88% sensitivity and 64% specificity for the detection of fresh blood. The test results were reviewed by a team of gastroenterologists and emergency physicians, and there was 92% on the findings.

"Video capsule endoscopy performed by emergency physicians was very accurate and nearly universally tolerated by patients," said lead study author Andrew Meltzer, MD. "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."

The findings, published online, also showed that when esophagoduodenoscopy is performed in the ED, as many as 46% of patients with acute gastrointestinal hemorrhages can be safely discharged home, saving hospitals thousands of dollars per patient.

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."