Esophagogastroduodenoscopy is the gold standard for evaluating suspected upper gastrointestinal bleeding but delays in access may complicate triage and resource management. PillSense, an FDA-approved ingestible capsule that detects presence of blood through optical absorption, provides a rapid and non-invasive diagnostic option with results available within ten minutes. This study assessed the real-world impact of this device on clinical decision-making and resource allocation while evaluating its safety profile.

A multicenter retrospective analysis was performed across two academic medical centers, including only patients with documented PillSense result. Patients were excluded for gastrointestinal obstruction, motility disorders, dysphagia, pregnancy, or implanted electromedical devices. Outcomes were compared between patients with positive and negative capsule results, including Glasgow Blatchford Score (GBS), transfusion requirements, hemodynamic instability, length of stay, thirty-day readmission, and adverse events. The influence of capsule findings on clinical management was recorded.

Seventy-five patients met inclusion criteria, of whom 24 (32%) had a positive capsule and 51 (68%) had a negative result. Patients with a positive result demonstrated substantially higher GBS (11.68 vs 7.62), required significantly more blood transfusions during hospitalization (mean 10.00 units vs 1.45 units), and experienced markedly longer hospital stays (14.83 days vs 3.87 days). The capsule was deployed in Emergency Department for 39 patients (52%) and in inpatient setting for 36 patients (48%) of which 12 were in intensive care unit (16%). Capsule findings influenced management in 70% of cases, including avoidance of EGD in 25%, prioritization of urgent EGD in 12%, and improved resource allocation in 63% (ED observation discharges n=18, stepdown bed assignment due to early detection of GI bleeding n=10, colonoscopy instead of EGD when upper GI bleed was excluded n=9); among patients who did not undergo EGD (n=12), there were no 30-day readmissions or adverse events.

This study demonstrates that the blood detection capsule is a safe and clinically valuable point-of-care tool for suspected upper gastrointestinal bleeding. Capsule results correlate meaningfully with bleeding severity, support more accurate triage, and reduce unnecessary procedures. Incorporation of this technology into routine practice may meaningfully decrease health care burden by improving diagnostic efficiency and supporting earlier and more appropriate allocation of endoscopic and inpatient resources.