Timing of video capsule endoscopy relative to overt obscure GI bleeding: implications from a retrospective study

Background Diagnostic yield of video capsule endoscopy (VCE) may be higher if it is performed closer to the time of overt obscure GI bleeding (OOGIB). Objective To evaluate the diagnostic yield of VCE and rate of therapeutic intervention for OOGIB for inpatients and outpatients with respect to timing of the intervention. Design Retrospective cohort study. Setting Tertiary academic center. Patients Patients who had VCE for OOGIB between August 2008 and August 2010. Interventions VCE for inpatients versus outpatients. Main Outcome Measures Diagnostic yield and rate of therapeutic intervention for inpatients versus outpatients. Results One hundred forty-four inpatients (65 women) and 116 outpatients (49 women) were included. Diagnostic yield was 65.9% for inpatients versus 53.4% for outpatients ( P = .054). Inpatients were divided into those who had VCE within 3 days (3 days; n = 54). Active bleeding and/or an angioectasia was found in 44.4% of the 3-day group ( P = .046) versus 25.8% of the outpatients. Therapeutic intervention was performed in 18.9% of the 3-day group ( P = .046) versus 10.3% of outpatients. Diagnostic yield and therapeutic intervention rate between the >3-day group and outpatients were not significantly different. Length of stay (days) was less in the 3-day cohort ( P < .0001). Limitations Long-term outcomes were not studied. This was a retrospective study. Conclusions Early deployment of VCE within 3 days of admission results in a higher diagnostic yield and therapeutic intervention rate and an associated reduction of length of stay.