title: Emergency video capsule endoscopy in patients with acute severe GI bleeding and negative upper endoscopy results.
abstract: BACKGROUND
  In mid-GI bleeding, video capsule endoscopy (VCE) shows the best diagnostic yield for ongoing overt bleeding. To date, the utility of VCE in acute severe GI bleeding has been analyzed rarely.
  
  
  OBJECTIVE
  To evaluate the impact of VCE when performed on patients with acute severe GI bleeding immediately after an initial negative upper endoscopy result.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Tertiary-care center.
  
  
  METHODS
  Patients with melena, dark-red or maroon stool, hemodynamic instability, drop of hemoglobin level ≥2 g/dL/day, and/or need of transfusion ≥2 units of packed red blood cells per day were included.
  
  
  METHODS
  After a negative upper endoscopy result, emergency VCE was performed by immediate endoscopic placement of the video capsule into the duodenum.
  
  
  METHODS
  Rate of patients in whom emergency VCE correctly guided further diagnostic and therapeutic procedures.
  
  
  RESULTS
  Upper endoscopy showed the source of bleeding in 68 of 88 patients (77%). In the remaining 20 patients (23%), emergency VCE was performed, which was feasible in 19 of 20 patients (95%; 95% confidence interval [CI], 75%-99%). Emergency VCE correctly guided further diagnostic and therapeutic procedures in 17 of 20 patients (85%; 95% CI, 62%-97%) and showed a diagnostic yield of 75% (95% CI, 51%-91%).
  
  
  CONCLUSIONS
  Single-center study, small sample size.
  
  
  CONCLUSIONS
  In patients with acute severe GI bleeding and negative upper endoscopy results, emergency VCE can be useful for the immediate detection of the bleeding site and is able to guide further therapy. (Clinical trial registration number: NCT01584869.)
authors.forename: Christoph
authors.initials: C
authors.lastname: Schlag
authors.forename: Christoph
authors.initials: C
authors.lastname: Menzel
authors.forename: Simon
authors.initials: S
authors.lastname: Nennstiel
authors.forename: Bruno
authors.initials: B
authors.lastname: Neu
authors.forename: Veit
authors.initials: V
authors.lastname: Phillip
authors.forename: Tibor
authors.initials: T
authors.lastname: Schuster
authors.forename: Roland M
authors.initials: RM
authors.lastname: Schmid
authors.forename: Stefan
authors.initials: S
authors.lastname: von Delius
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D062186:Arterial Pressure; D001803:Blood Transfusion; D053704:Capsule Endoscopy; D004630:Emergencies; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D006454:Hemoglobins