As these authors note, upper GI hemorrhage is responsible for almost 600,000 Emergency Department visits yearly – and there is some value and interest in risk-stratifying the suspect lesion with direct visualization. Enter the gastroenterologist.
But, wait! What if you could replace the on-call gastroenterologist and his endoscope with – a pill? That was the question these researchers, funded by an unrestricted grant from the capsule endoscopy manufacturers, tried to address.
Sadly, their study design is woefully inadequate – except for producing positive findings to return the favor to their funding source. A convenience sampling of 126 Emergency Physicians attending a conference watched four videos clipped only to footage of the stomach, three of which had blood present, and one of which did not. These physicians missed a few (94% sensitivity) and overcalled a few more (87% specific) from these handpicked test videos.
So, we have a surrogate endpoint for patient-oriented outcomes, an idealized simulated setting that is non-equivalent to clinical practice, and conflicts of interest with the manufacturer. The authors mention high “cost of capsule endoscopy” – and, at this point, I cannot see how this study does anything other than mislead readers this might be appropriate for an Emergency Department setting.
“Emergency Physicians Accurately Interpret Video Capsule Endoscopy Findings in Suspected Upper Gastrointestinal Hemorrhage: A Video Survey”
www.ncbi.nlm.nih.gov/pubmed/23859585