Beyond the weekend: great potential for photometric capsule-based risk assessment

10.1055/a-2679-6906

We congratulate Brand et al. on their recent study investigating the use of a photometric capsule to stratify patients with suspected nonvariceal upper gastrointestinal bleeding [1]. The concept of a device that reliably detects blood in the gastrointestinal tract and supports timing of inpatient endoscopy is certainly appealing. However, its optimal use in everyday clinical practice to save healthcare resources still needs a more precise definition.

The authors demonstrate convincingly that a negative photometric capsule examination (PCE) allows identification of low-risk patients who can undergo non-emergency endoscopy within 48–96 hours, without worsening outcome. The negative prognostic value of 100%, as well as avoidance of 95% of early endoscopies are striking results. Consequently, the use of PCE might have the potential to significantly decrease weekend on-call service demands by reducing the requirement for emergency endoscopies within 24 hours.

However, this benefit primarily applies to weekend patients presenting between Friday night and early Sunday morning, while on weekdays, early endoscopy during regular working hours, followed by timely discharge, has already been proven to be safe and cost-effective for stable patients with upper gastrointestinal bleeding [2]. Consequently, any savings from reduced weekend on-call services must be weighed against the additional costs of the capsule device, hospitalization, monitoring, medication, and the potential risk of nosocomial infections while awaiting endoscopy.

Looking forward, the potential of PCE may lie not in deferring inpatient endoscopy but rather in enabling safe outpatient management. As PCE appears to be a valuable tool for risk stratification, future studies should explore whether a negative PCE can reliably identify patients who could be safely discharged with outpatient endoscopy, even if their Glasgow–Blatchford Score is >1. This strategy may offer more substantial cost savings by reducing unnecessary hospitalization and emergency endoscopy.

Publication History

Article published online:
22 January 2026

• References

• 1 Brand M, Vogt G, Hann A. et al. Pilot study on using a photometric capsule to stratify patients with suspected nonvariceal upper gastrointestinal bleeding into emergency versus elective endoscopy. Endoscopy 2025;
• 2 Lee JG, Turnipseed S, Romano PS. et al. Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial. Gastrointest Endosc 1999; 50: 755-761