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Negative capsule endoscopy for obscure gastrointestinal bleeding is closely associated with the use of low-dose
Tomoaki Matsumura1, Makoto Arai, Sayuri Sazuka
1Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba-city, Japan.
Insights
Capsule endoscopy (CE) for obscure gastrointestinal bleeding (OGIB) can yield negative findings. Factors like anti-platelet drug use and delayed timing negatively impact CE diagnostic yield in OGIB patients.
Area of Science:
- Gastroenterology
- Medical Diagnostics
Background:
- Capsule endoscopy (CE) is a primary tool for diagnosing obscure gastrointestinal bleeding (OGIB).
- Negative findings from CE examinations remain a challenge in clinical practice.
Purpose of the Study:
- To identify factors associated with negative capsule endoscopy findings in patients with obscure gastrointestinal bleeding.
Main Methods:
- A retrospective analysis of 134 patients undergoing CE for overt or occult OGIB.
- Data collected included patient demographics, medication use (anti-coagulants, anti-platelet drugs, NSAIDs), comorbidities, and timing of CE relative to bleeding events.
Main Results:
- The overall diagnostic yield of CE was 50%.
- Multivariate analysis identified anti-platelet drug use (OR 2.69) and CE timing (≥16 days post-bleed, OR 2.32) as predictors of negative findings.
- For patients on low-dose aspirin (LDA), cessation before CE was a significant predictor of negative findings (OR 12.0).
Conclusions:
- Anti-platelet drug use, particularly low-dose aspirin (LDA), and its cessation before CE are associated with negative findings in OGIB patients.
- These factors may indicate rapid healing of LDA-related bleeding sources or very small lesions undetectable by CE.
Objective:
Capsule endoscopy (CE) is used widely for determining the cause of obscure gastrointestinal bleeding (OGIB). However, negative findings still arise from CE examination. The aim of this study was to determine the factors associated with negative findings on CE in patients with OGIB.
Material And Methods:
A total of 134 patients who underwent CE for overt (n = 104) or occult (n = 30) OGIB between October 2007 and April 2010 were included. The clinical backgrounds of the patients (age; sex; the use of anti-coagulant, anti-platelet drugs or NSAIDs; comorbidity and the timing of CE examination after bleeding) were noted.
Results:
The overall diagnostic yield of CE in detecting the relevant findings was 50% (n = 67). Multivariate analysis revealed that the use of anti-platelet drug and the timing of CE (≥ 16 days) were predictive factors for negative findings on CE (odds ratio 2.69 [1.01-7.21], p = 0.048 and odds ratio 2.32 [1.01-5.33], p = 0.047, respectively). Among the patients with the use of low-dose aspirin (LDA, n = 28) as anti-platelet drug, cessation of it before CE was the only predictive factor for negative findings on CE (odds ratio 12.0 [1.72-83.5], p = 0.012).
Conclusion:
In the patients with OGIB, the use of LDA and the cessation of it before CE made it difficult to detect the cause of bleeding by CE. This might indicate that the source of OGIB related to LDA heals immediately after cessation of the drugs or is a very small lesion that could not be detected by CE.
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