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Long-term outcome in patients with obscure gastrointestinal bleeding after capsule endoscopy
Wei Tan1, Zhi Zheng Ge, Yun Jie Gao
1Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China.
Insights
Capsule endoscopy (CE) for obscure gastrointestinal bleeding (OGIB) impacts long-term outcomes. Key rebleeding risks include older age, positive CE findings, low hemoglobin, nonspecific treatments, and post-procedure medications.
Area of Science:
- Gastroenterology
- Medical Diagnostics
- Clinical Research
Background:
- Obscure gastrointestinal bleeding (OGIB) presents diagnostic challenges.
- Capsule endoscopy (CE) is a primary tool for investigating OGIB.
- Long-term outcomes and rebleeding risk after CE require further elucidation.
Purpose of the Study:
- To identify risk factors for rebleeding after capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB).
- To evaluate the long-term outcomes associated with CE in OGIB management.
- To analyze cumulative rebleeding rates and associated predictors.
Main Methods:
- Retrospective review of consecutive patients undergoing CE for OGIB (June 2002 - January 2012).
- Cox proportional hazard model to assess risk factors for rebleeding.
- Kaplan-Meier survival curves and log-rank test for cumulative rebleeding rates.
Main Results:
- The overall rebleeding rate was 28.6% over a median 48-month follow-up.
- Independent risk factors for rebleeding included age ≥60, positive CE findings, hemoglobin ≤70 g/L, nonspecific treatments, and post-CE medication use (anticoagulants, antiplatelets, NSAIDs).
- Chronic hepatitis was associated with rebleeding in CE-negative patients.
Conclusions:
- Capsule endoscopy significantly influences the long-term prognosis of OGIB patients.
- Close follow-up and further investigation are crucial for OGIB patients, especially those with negative CE findings.
Objective:
This study aimed to identify the risk factors associated with rebleeding and long-term outcomes after capsule endoscopy (CE) for obscure gastrointestinal bleeding (OGIB) in a follow-up study.
Methods:
Data of consecutive patients who underwent CE due to OGIB from June 2002 to January 2012 were retrospectively reviewed. The Cox proportional hazard model was used to evaluate the risk factors associated with rebleeding, while Kaplan-Meier survival curves and the log-rank test were used to analyze cumulative rebleeding rates.
Results:
The overall rebleeding rate after CE in patients with OGIB was 28.6% (97/339) during a median follow-up of 48 months (range 12-112 months). Multivariate analysis showed that age ≥60 years (hazard ratio [HR] 2.473, 95% confidence interval [CI] 1.576-3.881, P = 0.000), positive CE findings (HR 3.393, 95% CI 1.931-5.963, P = 0.000), hemoglobin ≤70 g/L before CE (HR 2.010, 95% CI 1.261-3.206, P = 0.003), nonspecific treatments (HR 2.500, 95% CI 1.625-3.848, P = 0.000) and the use of anticoagulants, antiplatelet or non-steroidal anti-inflammatory drugs after CE (HR 2.851, 95% CI 1.433-5.674, P = 0.003) were independent risk factors associated with rebleeding. Univariate analysis showed that chronic hepatitis was independently associated with rebleeding in CE-negative patients (P = 0.021).
Conclusions:
CE has a significant impact on the long-term outcome of patients with OGIB. Further investigation and close follow-up in patients with OGIB and those with negative CE findings are necessary.
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