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MINERVA GASTROENTEROLOGICA E DIETOLOGICA
A Journal on Gastroenterology, Nutrition and Dietetics
Indexed/Abstracted in: CAB, EMBASE, PubMed/MEDLINE, Scopus, Emerging Sources Citation Index
Minerva Gastroenterologica e Dietologica 2010 December;56(4):383-7
Capsule endoscopy of the small bowel in the clinical practice: outpatient management is feasible and cheaper
Soncini M. 1, Russo A. 2, Campi E. 3, Lanzi P. 3, Colombo A. 3, Pometta R. 1, Colucci A. 1, Gasparini P. 1 ✉
1 Gastroenterology Unit, San Carlo Borromeo Hospital Milan, Milan, Italy
2 Epidemiology and Biostatistics Unit, San Carlo Borromeo Hospital Milan, Milan, Italy
3 Internal Medicine Department, San Carlo Borromeo Hospital Milan, Milan, Italy
AIM. Four Italian regions have cost coding for outpatient capsule-endoscopy. Elsewhere it is performed in ordinary hospital admission. To identify, in a cohort of patients of a Gastroenterology Unit, those feasible for outpatient versus inpatient treatment; to analyze costs distribution in both management areas.
METHODS: We retrospectively analysed 100 clinical records of admissions to A.O. San-Carlo-Borromeo, Milan between 2005-2008. Hospitalization criteria (at least 3): 1) occult/obscure gastrointestinal bleeding; 2) hemoglobin ≤8 gr/dL; 3) indication for blood transfusions; 4) urgent hospital admission.
RESULTS: A total of 62 patients had urgent admission, 60 blood transfusions, 81 underwent EGD and colonoscopy, 8 enteroscopy and 5 surgery. Mean haemoglobin value was 8.67 g/dL. Capsule-endoscopy was positive in 70, uncertain in 8, negative in 22. Positive cases: 33 angiodyplasia, 18 ulcers/erosions, 13 polyps/masses, 5 overt bleeding, 1 celiac disease. 47/100 were appropriate as outpatient, saving 432 days of hospital stays. Admission coding was grouped into 7 DRGs (overall expense: 98,366 Euros). Considering EGD/colonoscopy outpatient costs and € 1 100 euros as estimated value for capsule-endoscopy, the total expense could be € 53 919.
CONCLUSION: Outpatient capsule-endoscopy small bowel examination is feasible in half of the cases. It is cost saving, (about € 45 000 Euros/100 patients), reducing inappropriate hospital stays.