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The systematized approach to patients with small bowel bleeding (SBB) can reduce risks and costs for both patients and the Unified Health System (SUS).
Evaluate the evolution of the systematized approach to SBB in a regulated, hierarchically organized healthcare network of varying complexity.
Analysis of the medical records of patients with SBB treated at a tertiary, public, and teaching hospital in two distinct periods: before the implementation of a specialized service and algorithm for SBB (2001–2014, group without algorithm—GSA) and after the establishment of a trained, dedicated team, availability of capsule endoscopy and enteroscopy (2015–2023, group with algorithm—GCA). Demographic, clinical, and care-related data from 184 patient records were collected and entered into the REDCap platform. Additionally, a cost analysis was conducted.
Among the 184 patients, 82 (45%) were in the GSA group and 102 (55%) in the GCA group. The average number of specific exams per patient was 7.19 in GSA and 6.37 in GCA (p=0.02, p<0.05). Blood transfusions were performed in 64 patients (78.05%) in GSA and 68 patients (66.67%) in GCA (p=0.05). The average time to reach diagnosis was 309.9 weeks in GSA and 75.37 weeks in GCA (p<0.01). The average hospital stay was 7.57 weeks in GSA and 2.55 weeks in GCA (p<0.01). In GSA, 19 patients (23.2%) died due to SBB, while in GCA only six did (5.9%) (p=0.001, p<0.05). The average cost was higher compared to GCA (p<0.01).
The results of organizing a reference service for SBB care support are sufficient to subsidize the planning of services and regional healthcare networks.
The small-bowel is the most difficult segment to be visualized by traditional endoscopic methods. The need for its exploration led to the development of capsule endoscopy. The percentage of the complete examination varies and still remains uncertain the factors that influence the complete and incomplete examination.
Evaluate the factors that interfere with the completeness of the endoscopic evaluation by the capsule.
A prospective study in which were included 939 patients divided into two groups: complete group (CG) and incomplete group (IG). The studied variables that could interfere were: age, gender, comorbidities, diagnosis of Crohn’s disease, previous abdominal surgery, inadequate preparation to compare the groups reached and did not reach the cecum.
Of the 939 patients included 879 (93.3%) reached the cecum (CG) and 63 (6.7%) IG no. The IG was composed of 29 (46.0%) men and 34 (54.0%) women with a mean age of 49.7 years; comorbidities this group accounted for 46% of which 15.9% was Crohn’s disease, previous abdominal surgery 22.2% and 17.5% inadequate preparation.
Factors associated with complete or incomplete outcome of the examination with capsule endoscopy were: associated comorbidities, Crohn’s disease, previous abdominal surgery and inadequate preparation.
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