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Can video capsule endoscopy be safely used as an alternative to standard endoscopic procedures for the initial evaluation of gastrointestinal bleeding during the COVID-19 pandemic?
In this cohort study of 146 patients (74 with COVID-19), active bleeding was more frequently identified with video capsule endoscopy as the first strategy (59.5%) compared with conventional endoscopic evaluation (25.0%). The number of invasive procedures was significantly decreased with video capsule endoscopy without increased risk of rebleeding or compromising safety.
The results of this study suggest that video capsule endoscopy can serve as a safe alternative to the standard endoscopic evaluation of gastrointestinal bleeding because it reduces the number of invasive procedures, personnel involved, and use of personal protective equipment.
Evaluation of acute gastrointestinal (GI) bleeding using invasive endoscopic procedures comprising the standard of care (SOC)—upper endoscopy and colonoscopy—can expose the endoscopy staff to SARS-CoV-2. Video capsule endoscopy (VCE) does not generate aerosols and only requires 1 person to manage the procedure.
To examine the safety of VCE for the initial evaluation of GI bleeding at the peak of the COVID-19 pandemic to identify signs of active bleeding while minimizing patient and personnel exposure, saving personal protective equipment, and avoiding invasive or unnecessary procedures.
Design, Setting, and Participants
A multicenter (UMass Memorial Medical Center and Louisiana State University Health Sciences Center) retrospective cohort study including 146 patients with COVID-19 who received VCE as the first-line diagnostic modality was conducted from March 15 to June 15, 2020, compared with SOC in January 2020 for evaluation of GI bleeding. The association between treatment and outcomes was estimated using multivariable regression adjusting for potential confounders. Propensity score matching was used to verify the results.
Main Outcomes and Measures
The primary end point was detection of active bleeding or stigmata of recent bleeding. Secondary end points included the number of patients requiring any invasive procedures, number of additional procedures, rates of rebleeding and rehospitalization, transfusion requirements, and mortality.
Among 146 patients, 92 (63.0%) were men; mean (SD) age was 64.93 (14.13) years in the COVID-19 group and 61.33 (13.39) years in the SOC group. Active bleeding or stigmata of recent bleeding was observed in 44 (59.5%) patients in the COVID-19 group compared with 18 (25.0%) in the SOC group (adjusted odds ratio, 5.23; 95% CI, 2.23 to 12.27). Only 36 patients (48.7%) in the COVID-19 group required any invasive procedure during the hospitalization compared with 70 (97.2%) in the SOC group (adjusted odds ratio, 0.01; 95% CI, 0.001 to 0.08). The mean (SD) number of invasive procedures was 0.59 (0.77) per patient in the COVID-19 group compared with 1.18 (0.48) per patient in the SOC group (adjusted difference, −0.54; 95% CI, −0.77 to −0.31). Both approaches appeared to be safe and there was no significant difference in transfusion requirements, rebleeding, rehospitalization, or in-hospital mortality. No mortality was attributed to GI bleeding in either group.
Conclusions and Relevance
In this cohort study, first-line diagnostic evaluation of acute GI bleeding using VCE appeared to be a safe and useful alternative to the traditional approach of upper endoscopy and colonoscopy. Use of VCE was associated with increased detection of active bleeding and a reduced number of invasive procedures and unnecessary exposure of personnel to SARS-CoV-2 and use of personal protective equipment.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: May 24, 2021.
Published: July 30, 2021. doi:10.1001/jamanetworkopen.2021.18796
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Hakimian S et al. JAMA Network Open.
Corresponding Author: Shahrad Hakimian, MD, Department of Medicine, Division of Gastroenterology, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA 01655 (email@example.com).
Author Contributions: Dr Hakimian had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Hakimian, Raines, Rau, Foley, Cave.
Acquisition, analysis, or interpretation of data: Hakimian, Raines, Reed, Hanscom, Stefaniwsky, Petersile, Rau.
Drafting of the manuscript: Hakimian, Raines, Rau, Cave.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Hakimian, Raines, Reed, Rau.
Administrative, technical, or material support: Raines, Hanscom, Stefaniwsky, Petersile, Rau, Foley, Cave.
Supervision: Raines, Cave.
Conflict of Interest Disclosures: Ms Foley reported receiving grants from Olympus Corp supporting a clinical trial evaluating capsule endoscopy outside the submitted work. Dr Cave reported receiving grants from Medtronic, Olympus Corp, and AnX Robotics outside the submitted work and is a contributor to UpToDate. No other disclosures were reported.
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