Introduction: Video capsule endoscopy (VCE) has become an important tool for small bowel evaluation, but its use in the inpatient setting remains controversial as it can have complications (e.g. retention) and increase hospital costs. We investigated whether using VCE resulted in subsequent inpatient procedures that improved inpatient care and overall resource use.
Methods: This is a single-center observational study involving inpatients who presented to SBUH and underwent VCE from 1/1/2018 through 1/1/2022. We used Chi-square testing to determine significance among our categorical variables and used t-tests to compare means for our numerical variables as well multivariable logistic regression to analyze risk factors for increased hospital stay. All statistical analysis was done in R (R Core Team, 2020).
Results: We identified 206 inpatients, including 83 women (40.3%), who underwent VCE from 1/1/2018 through 1/1/2022. Amongst all the listed indications for VCE deployment, melena was the least likely to resolve prior VCE (OR 0.14, 0.07-0.27, p< 0.0001). Melena was also the only variable found to be associated with undertaking of subsequent procedures (OR 2.3, [1.3-4.1], p< 0.0001). Sex, race, body mass index, and other GI-related complaints were not associated with patients’ having further procedures or identification of a bleeding or abdominal pain source.
Male patients were more likely to be readmitted for bleeding (OR 2.04, [1.04-4.2], p=0.04) while patients who had a stable hemoglobin level (Hgb) prior to VCE deployment were less likely to be readmitted (OR 0.98, [0.96-0.99], p=0.01). Patients with a stable Hgb prior to VCE deployment were discharged after VCE deployment slightly faster than patients without a stable Hgb level prior to deployment (0.05 days, p=0.01). Patients who were not readmitted had a mean 36.3 hours of hemoglobin stability prior to VCE deployment vs. 27.4 hours of hemoglobin stability prior to VCE deployment in those who were readmitted (p=0.01).
Discussion: VCE has become an important tool in the evaluation of the GI tract, though its utility appears to be most pronounced in men, in patients with melena, and in those with unstable hemoglobin levels. We are developing a risk stratification tool for inpatients who would benefit most from VCE and are also gathering information from prior years for further analysis.
