Early Capsule Endoscopy in Acute Upper Gastrointestinal Bleeding.

All patients with upper gastrointestinal bleeding (UGIB) undergo a gastroscopy urgently. However, in a significant proportion of these patients a source is not identified. Small bowel bleeding is highly likely to be the source in a large number of these patients. This may be identified by capsule endoscopy. Proximal colonic bleeding is also likely in patients with melaena and is identifiable by colonoscopy. As per current standard practice, patients will undergo a colonoscopy frequently or a capsule endoscopy (CE) less often, in an attempt to find the cause of bleeding. Capsule endoscopy is noninvasive, better tolerated and preferred by patients as bowel prep and anaesthesia are not required. However,it is uncertain who will benefit most by having a capsule endoscopy as the second test. The focus of our study is to look at the subgroup of patients who will benefit most by having early Capsule Endoscopy in this context. The study aims to compare two groups of patients, one having capsule endoscopy VS the other having colonoscopy as the second test following a negative gastroscopy to determine differences in ability to detect bleeding source and therefore change patient outcome. All patients with UGIB with a negative gastroscopy will be considered for the study. This is a prospective randomised control trial. Primary endpoint measured will be identification of the source of bleeding. Secondary endpoints measured will be reduced blood transfusions, reduced length of stay, reduced number of investigations and reduced hospital admissions.