Capsule Endoscopy for Hemorrhage in the Emergency Room
Capsule Endoscopy for Hemorrhage in the Emergency Room
The researcher's primary hypothesis is that VCE allows for safe outpatient management of ED
 patients with suspected upper GI hemorrhage. A prospective multicenter randomized control
 trial was designed to investigate the safety of this approach.
The typical primary care, urgent care or emergency care provider is unable to evaluate common
 and serious conditions of the gastrointestinal tract such as a bleeding peptic ulcer. As
 such, more than 80% of patients who present to US ED's with suspected bleeding in their upper
 GI tract require hospitalization, procedural sedation by an anesthesiologist, and a
 traditional tube-based upper endoscopy by a gastroenterologist. While this traditional
 process is safe and effective, it is not efficient for our low-risk patients and not timely
 for our high-risk patients. The opportunity to bring Video Capsule Endoscopy to the
 front-lines of US medical care will revolutionize how we manage upper GI bleeding and shed
 light on critical diseases that have heretofore been hidden from most providers. This trial
 is an important step toward demonstrating that VCE is a safe and effective tool to
 risk-stratify upper GI bleeding and improve quality of emergency care for all patients.
Subject Inclusion Criteria

 1. Individuals aged ≥ 18 years presenting to the Emergency Department with acute, overt
 UGIB defined as bloody emesis and/or coffee ground vomiting and/or melena within the
 previous 48 hours.

 Subject Exclusion Criteria

 1. Upper GI Bleed with hemodynamic shock (BP<90mmHg and pulse>120 per minute)

 2. Active hematemesis

 3. Known history of gastric cancer

 4. Known history of gastric or esophageal varices

 5. GI surgery within the last 6 months

 6. Dysphagia, swallowing disorder, Zencker's diverticulum, suspected bowel obstruction or
 perforation

 7. Gastroparesis, Gastric outlet obstruction, Crohn's disease, past UGI tract surgery
 (e.g., Bilroth I or II, esophagectomy, gastrectomy, bariatric procedure)

 8. Other contraindications to VCE per manufacturer (Medtronic)

 9. Pregnancy/ lactation

 10. Prisoner

 11. Altered mental status (e.g., hepatic encephalopathy) that limits the ability to
 swallow a capsule

 12. Expected to have Magnetic Resonance Imaging examination within 7 days.

 13. On medications that may coat the upper GI tract such as antacids or sucralfate or
 Maalox.

 14. Patient either refuses or is unable to get traditional EGD.

 15. Patient does not have reliable contact information - no phone, no permanent address.

 16. Patient refuses / chooses to withdraw (at any time) / unable to provide written
 consent.

 17. Non-English speaker