Alamro Sulaiman M, Alanazi Mazi M, Suwayyid Wejdan K
Emergency Medicine, Qassim University, Buraidah, SAU.
Emergency Medicine, King Saud Medical City, Riyadh, SAU.
Cureus. 2024 Oct 15;16(10):e71530. doi: 10.7759/cureus.71530. eCollection 2024 Oct.
Gastrointestinal bleeding is a common occurrence in emergency departments. The standard of care for it is an esophagogastroduodenoscopy within 24 hours to diagnose and potentially treat the bleeding. Several tools and pre-endoscopic risk assessment scores are used to help evaluate and manage upper gastrointestinal bleeding. Additionally, capsule endoscopy provides a non-invasive method to visualize the gastrointestinal tract and identify lesions. The aim of this review was to explore the role of capsule endoscopy in the triage, stratification, and management of upper gastrointestinal bleeding patients in the emergency department. Four databases, PubMed, Scopus, Embase, and the Cochrane Library, were searched using keywords related to capsule endoscopy and gastrointestinal bleeding in the emergency department. Studies were included if they assessed the use of capsule endoscopy in emergency settings for managing upper gastrointestinal bleeding. After screening titles, abstracts, and full texts and reviewing bibliographies for relevant articles, data on study design, participant demographics, capsule endoscopy procedure description, and outcomes were collected into a pre-designed spreadsheet. The review focused on the triage, risk stratification, management impact, and safety of capsule endoscopy. The literature search identified 712 records, with 37 studies screened for full-text review, resulting in nine studies included in the review. These studies involved 634 patients and primarily compared capsule endoscopy with standard care in emergency settings. Capsule endoscopy demonstrated potential advantages, including improved identification of high-risk lesions and reduced hospital admissions. Capsule endoscopy effectively detected bleeding and reduced the need for invasive procedures compared to standard practices. Capsule endoscopy also had lower costs relative to traditional triaging methods. The use of capsule endoscopy in the risk stratification and management of upper gastrointestinal bleeding in emergency settings is promising. Its high diagnostic accuracy can enhance patient outcomes by enabling timely and precise diagnosis, reducing the need for invasive procedures. Future research should focus on larger randomized trials to validate capsule endoscopy's efficacy and explore its cost-effectiveness.
胃肠道出血在急诊科很常见。其护理标准是在24小时内进行食管胃十二指肠镜检查以诊断并可能治疗出血。有几种工具和内镜检查前风险评估评分用于帮助评估和管理上消化道出血。此外，胶囊内镜提供了一种可视化胃肠道并识别病变的非侵入性方法。本综述的目的是探讨胶囊内镜在急诊科对上消化道出血患者的分诊、分层和管理中的作用。使用与急诊科胶囊内镜和胃肠道出血相关的关键词搜索了四个数据库，即PubMed、Scopus、Embase和Cochrane图书馆。如果研究评估了胶囊内镜在急诊环境中对上消化道出血的管理应用，则纳入研究。在筛选标题、摘要和全文并查阅相关文章的参考文献后，将有关研究设计、参与者人口统计学、胶囊内镜检查程序描述和结果的数据收集到预先设计的电子表格中。该综述重点关注胶囊内镜的分诊、风险分层、管理影响和安全性。文献检索共识别出712条记录，筛选出37项研究进行全文审查，最终9项研究纳入本综述。这些研究涉及634名患者，主要在急诊环境中将胶囊内镜与标准护理进行比较。胶囊内镜显示出潜在优势，包括提高对高危病变的识别率和减少住院人数。与标准做法相比，胶囊内镜能有效检测出血并减少侵入性操作的需求。与传统分诊方法相比，胶囊内镜成本也更低。在急诊环境中，将胶囊内镜用于上消化道出血的风险分层和管理很有前景。其高诊断准确性可通过实现及时、精确的诊断来改善患者预后，减少侵入性操作的需求。未来的研究应侧重于更大规模的随机试验，以验证胶囊内镜的疗效并探索其成本效益。
