Negative capsule endoscopy in patients with obscure GI bleeding predicts low rebleeding rates

Wireless capsule endoscopy (CE) is the investigation of choice in obscure GI bleeding (OGIB), with a high diagnostic yield when compared with other modalities. It enables specific treatment to be instigated in a significant proportion of cases, with the aim of reducing rebleeding rates. Little evidence is currently available on the clinical value of a negative study.

To determine the long-term (>1 year) outcome in patients who underwent CE to investigate OGIB.

Consecutive patients with OGIB referred for CE to a single center over an 18-month period were identified. Follow-up data were obtained by reviewing case notes and an internal CE database. Rates of rebleeding were established, and factors associated with rebleeding were assessed by means of univariate and multivariate analysis.

Forty-nine patients underwent CE for investigation of OGIB (obscure overt in 25 patients [51%]) between April 2005 and October 2006. Long-term data were available for 42 patients (86%), with a mean (+/- SD) follow-up of 17.3 +/- 6.2 months. Significant (P2) lesions were identified in 24 patients (57%). The overall rebleeding rate was 28%. There was a statistically significant difference in rebleeding between patients with a positive and patients with a negative study, 42% versus 11%, respectively, P < .01. Anticoagulant use was also associated with an increased risk of rebleeding.

A negative CE study in patients with OGIB is associated with a low rate of recurrent bleeding in the long term (11%). It is reasonable to take an expectant approach with these patients, thus avoiding the need for unnecessary additional investigations.