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Small bowel capsule endoscopy in obscure gastrointestinal bleeding: normalcy is not reassuring
Tiago Cúrdia Gonçalves1, Francisca Dias de Castro, Maria João Moreira
1aGastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães bLife and Health Sciences Research Institute, University of Minho, Braga/Guimarães cICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal.
Insights
A negative small bowel capsule endoscopy (SBCE) for obscure gastrointestinal bleeding (OGIB) is not reassuring, as nearly a quarter of patients rebleed. Men are more likely to experience rebleeding, necessitating ongoing medical surveillance post-SBCE.
Area of Science:
- Gastroenterology
- Diagnostic Endoscopy
- Internal Medicine
Background:
- Small bowel capsule endoscopy (SBCE) is a key tool for diagnosing obscure gastrointestinal bleeding (OGIB).
- The long-term implications of a negative SBCE, including rebleeding risk, require further investigation.
Purpose of the Study:
- To evaluate outcomes in patients with OGIB and negative SBCE results.
- To assess follow-up duration, further diagnostic procedures, diagnosis rates, and rebleeding incidence.
- To identify factors associated with rebleeding after a negative SBCE.
Main Methods:
- Retrospective analysis of 256 patients undergoing SBCE for OGIB (April 2006-December 2011).
- Included 68 patients with negative SBCE results in a nested case-control analysis.
- Collected data on follow-up, rebleeding events, and patient demographics/comorbidities.
Main Results:
- Mean follow-up was 32 months for 68 patients (52 years old, 61.8% female).
- Rebleeding occurred in 16 patients (23.5%), with a mean onset of 15 months post-SBCE.
- Male sex was significantly associated with a higher rebleeding incidence (P=0.004).
Conclusions:
- Approximately 25% of OGIB patients with negative SBCE experience rebleeding, particularly men.
- A negative SBCE is not definitive, and rebleeding often occurs within two years.
- Regular medical surveillance is recommended for at least two years after a negative SBCE in OGIB patients.
Background/Aim:
Small bowel capsule endoscopy (SBCE) is currently a fundamental tool in the etiological study of obscure gastrointestinal bleeding (OGIB). However, the impact of a negative exam and the risk of rebleeding are not entirely known. The aim of this study was to evaluate the outcomes of patients with OGIB and a negative SBCE examination in terms of follow-up duration, additional diagnostic studies, and achievement of a diagnosis as well as to assess the incidence of rebleeding and possible associated factors.
Materials And Methods:
We retrospectively analyzed 256 patients who consecutively underwent an SBCE examination for the study of OGIB between April 2006 and December 2011, and then selected the 79 whose results excluded potentially bleeding lesions. Eleven patients were lost to follow-up and the remaining 68 were eligible for a nested case-control analysis. Pre-SBCE and post-SBCE information was collected, including follow-up interval and incidence of rebleeding, defined as admission to the hospital for symptomatic anemia, need for blood transfusion, decrease in hemoglobin value of greater than 2 g/dl, or evidence of melena or hematochezia. Univariate analysis included age, sex, OGIB presentation (occult or visible), hemoglobin levels at presentation, and comorbidities.
Results:
In the 68 patients analyzed, the mean age was 52±18 years and 61.8% were women. The OGIB was occult in 54 patients (79.4%) and overt in 14 patients (20.6%). Patients were followed up for an average of 32 months. Thirty-nine patients (57.4%) underwent further diagnostic investigations during the period of follow-up and a cause for the gastrointestinal bleeding was found in five of them. Rebleeding was documented in 16 (23.5%) patients, occurring on average 15±13.8 months after the SBCE. Male sex was associated significantly with higher incidence of rebleeding (P=0.004).
Conclusion:
Approximately one quarter of patients with OGIB and negative SBCE examination will experience rebleeding, with higher incidence among men; thus, a negative SBCE in this setting is not reassuring. As the vast majority of rebleeding episodes seem to occur within the following 2 years after SBCE, the maintenance of regular medical surveillance during the above-mentioned period of time after a negative SBCE seems advisable.
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