• Nidhi Shah, Chen Chen, Nataly Montano, David Cave, Rebecca Siegel, Nina T Gentile, Alexander T Limkakeng, Anita B Kumar, Yan Ma, and Andrew C Meltzer.
• The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, The Department of Emergency Medicine, 2120 L Street NW, Suite 450, Washington, DC 20037, USA. Electronic address: nidhishah@gwmail.gwu.edu.
• Am J Emerg Med. 2020 Jun 1; 38 (6): 1245-1252.

ObjectiveThe assessment of the severity of upper gastrointestinal hemorrhage in emergency department (ED) patients is difficult to assess with commonly available diagnostic tools. Small studies have shown that video capsule endoscopy (VCE) is a promising risk-stratification method and may be better than current clinical decision rules such as the Rockall score and the Glasgow Blatchford score. This review aims to assess the accuracy of VCE to detect active upper gastrointestinal hemorrhage compared to a reference standard.MethodsThe PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology was used to perform a review of studies that have measured the diagnostic accuracy of VCE. Studies were included if they measured ED use of VCE for upper GI hemorrhage as compared to a reference standard of an esophagogastroduodenoscopy (EGD). A meta-analysis was performed on select patients using a fixed effects and random-effects model to determine the primary outcome of diagnostic test accuracy.Results40 studies were screened for eligibility and five studies representing 193 patients met the inclusion and exclusion criteria. All patients received both a VCE and an EGD. The sensitivity and specificity of VCE were 0.724 and 0.748, respectively. The diagnostic odds ratio was 6.29 (95% CI: 3.23-12.25) and the summary receiver operating characteristic curve was 0.782.ConclusionsVCE demonstrated high accuracy for detecting upper GI hemorrhage in this meta-analysis of existing studies. In light of the potential advantages of VCE in the ED, further research is warranted to further establish its role.Copyright © 2020. Published by Elsevier Inc.

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