Nidhi Shah1, Chen Chen2, Nataly Montano3, David Cave4, Rebecca Siegel5, Nina T Gentile6, Alexander T Limkakeng7, Anita B Kumar8, Yan Ma9, Andrew C Meltzer10. 1. The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, The Department of Emergency Medicine, 2120 L Street NW, Suite 450, Washington, DC 20037, USA. Electronic address: nidhishah@gwmail.gwu.edu. 2. The George Washington University, Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, 950 New Hampshire Ave NW, 5th Floor, Washington, DC 20052, USA. Electronic address: joshuachen@gwmail.gwu.edu. 3. The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, The Department of Emergency Medicine, 2120 L Street NW, Suite 450, Washington, DC 20037, USA. Electronic address: nmontano@mfa.gwu.edu. 4. University of Massachusetts, UMass Memorial Medical Center, University Campus, 55 Lake Avenue North, Worcester, MA 01655, USA. 5. The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, The Department of Emergency Medicine, 2120 L Street NW, Suite 450, Washington, DC 20037, USA. 6. Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Medicine Education and Research Building (MERB), 3500 N. Broad Street, Philadelphia, PA 19140, USA. Electronic address: ngentile@temple.edu. 7. Division of Emergency Medicine, Duke University School of Medicine, 2301 Erwin Road, Box 3096, Durham, NC 27710, USA. Electronic address: alexander.limkakeng@duke.edu. 8. The George Washington University School of Medicine and Health Sciences, Department of Medicine, Division of Gastroenterology, The Department of Emergency Medicine, 2120 L Street NW, Suite 450, Washington, DC 20037, USA. Electronic address: abkumar@mfa.gwu.edu. 9. The George Washington University, Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, 950 New Hampshire Ave NW, 5th Floor, Washington, DC 20052, USA. Electronic address: yanma@gwu.edu. 10. The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, The Department of Emergency Medicine, 2120 L Street NW, Suite 450, Washington, DC 20037, USA. Electronic address: ameltzer@mfa.gwu.edu.
Abstract
OBJECTIVE: The assessment of the severity of upper gastrointestinal hemorrhage in emergency department (ED) patients is difficult to assess with commonly available diagnostic tools. Small studies have shown that video capsule endoscopy (VCE) is a promising risk-stratification method and may be better than current clinical decision rules such as the Rockall score and the Glasgow Blatchford score. This review aims to assess the accuracy of VCE to detect active upper gastrointestinal hemorrhage compared to a reference standard. METHODS: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology was used to perform a review of studies that have measured the diagnostic accuracy of VCE. Studies were included if they measured ED use of VCE for upper GI hemorrhage as compared to a reference standard of an esophagogastroduodenoscopy (EGD). A meta-analysis was performed on select patients using a fixed effects and random-effects model to determine the primary outcome of diagnostic test accuracy. RESULTS: 40 studies were screened for eligibility and five studies representing 193 patients met the inclusion and exclusion criteria. All patients received both a VCE and an EGD. The sensitivity and specificity of VCE were 0.724 and 0.748, respectively. The diagnostic odds ratio was 6.29 (95% CI: 3.23-12.25) and the summary receiver operating characteristic curve was 0.782. CONCLUSIONS: VCE demonstrated high accuracy for detecting upper GI hemorrhage in this meta-analysis of existing studies. In light of the potential advantages of VCE in the ED, further research is warranted to further establish its role.
OBJECTIVE: The assessment of the severity of upper gastrointestinal hemorrhage in emergency department (ED) patients is difficult to assess with commonly available diagnostic tools. Small studies have shown that video capsule endoscopy (VCE) is a promising risk-stratification method and may be better than current clinical decision rules such as the Rockall score and the Glasgow Blatchford score. This review aims to assess the accuracy of VCE to detect active upper gastrointestinal hemorrhage compared to a reference standard. METHODS: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology was used to perform a review of studies that have measured the diagnostic accuracy of VCE. Studies were included if they measured ED use of VCE for upper GI hemorrhage as compared to a reference standard of an esophagogastroduodenoscopy (EGD). A meta-analysis was performed on select patients using a fixed effects and random-effects model to determine the primary outcome of diagnostic test accuracy. RESULTS: 40 studies were screened for eligibility and five studies representing 193 patients met the inclusion and exclusion criteria. All patients received both a VCE and an EGD. The sensitivity and specificity of VCE were 0.724 and 0.748, respectively. The diagnostic odds ratio was 6.29 (95% CI: 3.23-12.25) and the summary receiver operating characteristic curve was 0.782. CONCLUSIONS: VCE demonstrated high accuracy for detecting upper GI hemorrhage in this meta-analysis of existing studies. In light of the potential advantages of VCE in the ED, further research is warranted to further establish its role.
Authors: Andrew C Meltzer; Alexander T Limkakeng; Nina T Gentile; Jincong Q Freeman; Nicole C Hall; Nataly Montano Vargas; David E Fleischer; Zubair Malik; Samuel J Kallus; Marie L Borum; Yan Ma; Anita B Kumar Journal: J Am Coll Emerg Physicians Open Date: 2021-10-25