Year 2015 / Volume 107 / Number 12
Original
What is the long-term outcome of a negative capsule endoscopy in patients with obscure gastrointestinal bleeding?

753-758

DOI: 10.17235/reed.2015.3900/2015

Iolanda Ribeiro, Rolando Pinho, Adélia Rodrigues, Joana Silva, Ana Ponte, Jaime Rodrigues, João Carvalho,

Abstract
Background and aims: There are contradictory findings regarding long-term outcome in patients with obscure gastrointestinal bleeding and negative capsule endoscopy. Factors associated with rebleeding after a negative videocapsule are not entirely known. Objective: The aim of this study was to compare the rebleeding rate between negative and positive capsule endoscopy patients and to identify predictive factors for rebleeding in patients with negative findings. Material and methods: Consecutive patients with obscure gastrointestinal bleeding referred to a single center over a period of 5 years were identified. After exclusion of patients with a follow time < 6 months, 173 patients were included. Clinical information was retrospectively collected from medical records. Rebleeding was defined as evidence of melena/hematochezia, a drop in hemoglobin of ≥ 2 g/dL, or the need for transfusion 30 days after the index episode. Results: The mean age was 61.7 years and 60% were female. The median follow up time was 27 months. Most patients were referred for occult gastrointestinal bleeding (67.1%) while 32.9% were referred for overt bleeding. More than 50% of the patients had negative capsule endoscopy. The rebleeding rate in negative capsule endoscopy is 16%, with a mean follow-up time of 25.8 months and is significantly lower than positive capsule endoscopy (16% vs. 30.2%, p = 0.02). Rebleeding after negative capsule endoscopy is higher in patients who need more transfusions of packet red blood cells before capsule endoscopy (3.0 vs. 0.9, p = 0.024) and have overt bleeding (46% vs. 13.9%, p = 0.03). In 53% of these patients, rebleeding occurs > 12 months after a negative capsule endoscopy. Conclusions: Patients with obscure gastrointestinal bleeding and a negative capsule endoscopy had a significantly lower rebleeding rate and can be safely followed. However, a higher transfusion of red blood cells previous to capsule endoscopy and an overt bleeding are associated with a higher rebleeding. So, it is reasonable to consider that these patients may benefit of at least one year of follow-up.
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References
1 Raju GS, Gerson L, Das A et al. American Gastroenterological Association. American Gastroenterological Association medical position statement: evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 2007; 133:1694-6. DOI: 10.1053/j.gastro.2007.06.008
2 Raju GS, Gerson L, Das A et al. American Gastroenterological Association (AGA) Institute technical review on obscure gastrointestinal bleeding. Gastroenterology 2007; 133: 1694-6 ID: 17983812] DOI: 10.1053/j.gastro.2007.06.007
3 Prakash C, Zuckerman GR. Acute small bowel bleeding: a distinct entity with significantly different economic implications compared with GI bleeding from other locations. Gastrointest Endosc 2003;58:330–5 DOI: 10.1016/S0016-5107(03)00003-8
4 Saurin JC, Delvaux M, Vahedi K et al. Clinical impact of capsule endoscopy compared to push enteroscopy: 1-year follow-up study. Endoscopy 2005; 37: 318-23 DOI: 10.1055/s-2005-861114
5 Costamagna G, Shah SK, Riccioni ME et al. A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease. Gastroenterology 2002; 123: 999-1005 DOI: 10.1053/gast.2002.35988
6 Hara AK, Leighton JA, Sharma VK et al. Small bowel: preliminary comparison of capsule endoscopy with barium study and CT. Radiology 2004; 230: 260-5 DOI: 10.1148/radiol.2301021535
7 Fisher L, Lee Krinsky M, Anderson MA et al. The role of endoscopy in the management of obscure gastrointestinal bleeding. Gastrointestinal Endoscopy 2010; 3: 471-9. DOI: 10.1016/j.gie.2010.04.032
8 Ribeiro I, Rolando P, Rodrigues A, et al. The Importance of Alternative Diagnostic Modalities in the Diagnosis of Small Bowel Tumors After a Negative Capsule Endoscopy. GE Portuguese Journal of Gastroenterology 2015; 22: 112–6
9 Park J, Cheon J, Kim H et al. Negative capsule endoscopy without subsequent enteroscopy does not predict lower long-term rebleeding rates in patients with obscure GI bleeding. Gastrointest Endosc. 2010; 71:990-7 DOI: 10.1016/j.gie.2009.12.009
10 Riccioni M, Urgesi R, Cianci R et al. Negative capsule endoscopy in patients with obscure gastrointestinal bleeding reliable: Recurrence of bleeding on long-term follow-up. World J Gastroenterol 2013; 19: 4520-5. DOI: 10.3748/wjg.v19.i28.4520
11 Saurin JC, Delvaux M, Vahedi K et al. Clinical impact of capsule endoscopy compared to push enteroscopy: 1-year follow-up study. Endoscopy 2005; 37: 318-23. DOI: 10.1055/s-2005-861114
12 Rondonotti E, Herrerias JM, Pennazio M et al. Complications, limitations, and failures of capsule endoscopy: a review of 733 cases. Gastrointest Endosc 2005; 62:712–6 DOI: 10.1016/j.gie.2005.05.002
13 Matsumura T, Arai M, Saito K et al. Predictive factor of re-bleeding after negative capsule endoscopy for obscure gastrointestinal bleeding: Over 1-year follow-up study. Digestive Endoscopy 2014; 26: 650–8. DOI: 10.1111/den.12257
14 Macdonald J, Porter V, McNamara D. Negative capsule endoscopy in patients with obscure GI bleeding predicts low rebleeding rates. Gastrointest Endosc 2008;68:1122-7 DOI: 10.1016/j.gie.2008.06.054
15 Shahidi NC, Ou G, Svarta S, et al. Factors Associated With Positive Findings From Capsule Endoscopy in Patients With Obscure Gastrointestinal Bleeding. Clin Gastroenterol Hepatol 2012;10:1381–5 DOI: 10.1016/j.cgh.2012.08.035
16 Lai LH, Wong GL, Chow DK et al. Long-term follow-up of patients with obscure gastrointestinal bleeding after negative capsule endoscopy. Am J Gastroenterol 2006; 101: 1224-8 DOI: 10.1111/j.1572-0241.2006.00565.x
17 Ribeiro I, Pinho R, Rodrigues A et al. Obscure gastrointestinal bleeding: which factors are associated with positive capsule endoscopy findings? Rev Esp Enferm Dig. 2015;107:334-9
18 Pinto-Pais T, Pinho R, Rodrigues A et al. Emergency single-balloon enteroscopy in overt obscure gastrointestinal bleeding: Efficacy and safety. United European Gastroenterol J. 2014; 2:490-6. DOI: 10.1177/2050640614554850
19 Jackson CS, Gerson LB. Management of gastrointestinal angiodysplastic lesions (GIADs): a systematic review and meta-analysis. Am J Gastroenterol 2014;109:474-83. DOI: 10.1038/ajg.2014.19
20 Koh S, Im J, Kim J, et al. Long-term outcome in patients with obscure gastrointestinal bleeding after negative capsule endoscopy. World J Gastroenterol 2013; 19: 1632-8. DOI: 10.3748/wjg.v19.i10.1632
21 Curdia Gonçalves T, Dias de Castro F, Moreira MJ, et al. Small bowel capsule endoscopy in obscure gastrointestinal bleeding: normalcy is not reassuring. Eur J Gastroenterol Hepatol. 2014;26:927-32 DOI: 10.1097/MEG.0000000000000135
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Ribeiro I, Pinho R, Rodrigues A, Silva J, Ponte A, Rodrigues J, et all. What is the long-term outcome of a negative capsule endoscopy in patients with obscure gastrointestinal bleeding?. 3900/2015


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Publication history

Received: 22/06/2015

Accepted: 09/09/2015

Online First: 02/11/2015

Published: 03/12/2015

Article revision time: 71 days

Article Online First time: 133 days

Article editing time: 164 days


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