Frequency of Rebleeding Events in Obscure Gastrointestinal Bleeding With Negative Capsule Endoscopy

Ji-Beom Kim; Byong Duk Ye; Yelim Song; Dong-Hoon Yang; Kee Wook Jung; Kyung-Jo Kim; Jeong-Sik Byeon; Seung-Jae Myung; Suk-Kyun Yang; Jin-Ho Kim

Disclosures

J Gastroenterol Hepatol. 2013;28(5):834-840. 

In This Article

Abstract and Introduction

Abstract

Background and Aims: Although capsule endoscopy (CE) is widely used as a first-line diagnostic modality for obscure gastrointestinal bleeding (OGIB), the rebleeding rate after negative CE varies according to different studies. We tried to elucidate the outcomes after negative CE for OGIB and to determine the risk factors associated with rebleeding.

Methods: We retrospectively reviewed data from 125 patients who had received CE for OGIB.

Results: PillCam SB capsules were used for 92 patients (73.6%) and SB2 capsules for the other 33 (26.4%). The complete visualization of the small bowel was achieved in 93 patients (74.4%). Of the 63 patients (50.4%) who showed negative CE results, 60 patients did not receive any further specific treatment for OGIB, and were analyzed for the rebleeding rate and risk factors for rebleeding. Of the 60 patients, rebleeding episodes were observed in 16 patients (26.7%), and the cumulative rebleeding rates after 6, 12, 24, and 36 months were 12.4%, 14.3%, 28.7%, and 35.9%, respectively. Substantial rebleeding events were observed with similar frequency both after negative CE without subsequent treatment (26.7%) and after positive CE without specific treatment (21.2%) (P = 0.496).

Conclusions: Considerable rebleeding episodes were observed after negative CE result for OGIB. Further complementary diagnostic work-ups and close follow-up are needed to be considered for patients with OGIB and negative CE results.

Introduction

Obscure gastrointestinal bleeding (OGIB) is a disease entity with variable causes that presents a diagnostic and therapeutic challenge to gastroenterologists. OGIB is defined as a bleeding of unknown origin that persists or recurs after esophagogastroduodenoscopy, colonoscopy, and radiologic evaluation of the small bowel.[1]

Recently, capsule endoscopy (CE) has been found to have value in the clinical assessment of patients with presumed small bowel diseases, as this technique provides a non-invasive evaluation of the entire small bowel. For OGIB, CE is recommended as an initial investigation modality for the detection of a bleeding source.[2–4] However, even after full evaluation of the small bowel with CE, the diagnostic yield of CE for OGIB ranges between 32% and 76%,[4–7] which means that CE is not a perfect tool for detecting the bleeding focus. When a confirmatory diagnosis is made after CE study, specific treatments can be applied according to the diagnosis made using CE. A recent report has shown that the rebleeding rate decreases after specific treatment for bleeding focus revealed through CE.[8]

In cases where CE is negative for OGIB, on the other hand, the long-term prognosis presented as rebleeding rates, varies. Although some studies have described a rebleeding rate of 5.6–11.1% after negative CE,[9,10]other recent studies have reported rebleeding rates ranging between 28.1% and 50%.[8,11,12] All of these studies, however, included a small number of patients; thus, a larger-scaled study is needed to elucidate the long-term prognosis of patients with negative CE for OGIB.

In the present study, we sought to reveal the outcomes after negative CE for OGIB and the risk factors associated with rebleeding.

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