title: Capsule endoscopy of the small bowel in the clinical practice: outpatient management is feasible and cheaper.
abstract: OBJECTIVE
  Four Italian regions have cost coding for outpatient capsule-endoscopy. Elsewhere it is performed in ordinary hospital admission. To identify, in a cohort of patients of a Gastroenterology Unit, those feasible for outpatient versus inpatient treatment; to analyze costs distribution in both management areas.
  
  
  METHODS
  We retrospectively analysed 100 clinical records of admissions to A.O. San-Carlo-Borromeo, Milan between 2005-2008. Hospitalization criteria (at least 3): 1) occult/obscure gastrointestinal bleeding; 2) hemoglobin ≤ 8 gr/dL; 3) indication for blood transfusions; 4) urgent hospital admission.
  
  
  RESULTS
  A total of 62 patients had urgent admission, 60 blood transfusions, 81 underwent EGD and colonoscopy, 8 enteroscopy and 5 surgery. Mean haemoglobin value was 8.67 g/dL. Capsule-endoscopy was positive in 70, uncertain in 8, negative in 22. Positive cases: 33 angiodyplasia, 18 ulcers/erosions, 13 polyps/masses, 5 overt bleeding, 1 celiac disease. 47/100 were appropriate as outpatient, saving 432 days of hospital stays. Admission coding was grouped into 7 DRGs (overall expense: 98,366 Euros). Considering EGD/colonoscopy outpatient costs and 1.100 euros as estimated value for capsule-endoscopy, the total expense could be 53.919.
  
  
  CONCLUSIONS
  Outpatient capsule-endoscopy small bowel examination is feasible in half of the cases. It is cost saving, (about 45.000 Euros/100 patients), reducing inappropriate hospital stays.
authors.affiliation: San Carlo Borromeo Hospital Milan, Milan, Italy. soncini.marco@sancarlo.mi.it
authors.forename: M
authors.initials: M
authors.lastname: Soncini
authors.forename: A
authors.initials: A
authors.lastname: Russo
authors.forename: E
authors.initials: E
authors.lastname: Campi
authors.forename: P
authors.initials: P
authors.lastname: Lanzi
authors.forename: A
authors.initials: A
authors.lastname: Colombo
authors.forename: R
authors.initials: R
authors.lastname: Pometta
authors.forename: A
authors.initials: A
authors.lastname: Colucci
authors.forename: P
authors.initials: P
authors.lastname: Gasparini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D053704:Capsule Endoscopy / Q000191:economics* / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000191:economics* / Q000209:etiology / Q000601:surgery; D006801:Humans; D007297:Inpatients; D007421:Intestine, Small / Q000000981:diagnostic imaging* / Q000601:surgery; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014463:Ultrasonography