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Long-Term Outcomes in Patients with Overt Obscure Gastrointestinal Bleeding After Negative Double-Balloon Endoscopy
Satoshi Shinozaki1,2, Tomonori Yano3, Hirotsugu Sakamoto4
1Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. shinozaki-s@aqua.ocn.ne.jp.
Insights
Patients experiencing obscure gastrointestinal bleeding may rebleed after a negative double-balloon endoscopy (DBE). Repeat endoscopic evaluation is crucial for identifying bleeding sources and guiding treatment in these cases.
Area of Science:
- Gastroenterology
- Endoscopy
- Digestive Diseases
Background:
- Long-term outcomes following negative double-balloon endoscopy (DBE) for obscure gastrointestinal (GI) bleeding are not well-established.
- Obscure GI bleeding presents diagnostic challenges, often requiring advanced endoscopic techniques.
Purpose of the Study:
- To evaluate the long-term outcomes of patients with negative DBE for obscure GI bleeding.
- To determine the impact of repeat endoscopic work-up on patient outcomes after initial negative DBE.
Main Methods:
- Retrospective review of clinical data from 42 patients with negative DBE for overt obscure GI bleeding.
- Mean follow-up period of 5.4 years, monitoring for overt rebleeding.
- Further endoscopic work-up and specific treatments were administered upon rebleeding events.
Main Results:
- A significant rebleeding rate of 38% (16 out of 42 patients) was observed.
- Repeat investigations identified the bleeding source in 71% of rebleeding patients, predominantly in the small intestine (70%).
- Pre-DBE blood transfusion and multiple prior bleeding episodes were significant predictors of rebleeding.
Conclusions:
- The rebleeding rate after a negative DBE for obscure GI bleeding is considerable.
- Long-term surveillance and repeat endoscopic evaluation are essential for managing patients with obscure GI bleeding.
- Timely identification and treatment of rebleeding sources improve patient outcomes.
Background:
The long-term outcomes of patients after negative double-balloon endoscopy (DBE) for obscure gastrointestinal (GI) bleeding remain unclear.
Aim:
The aim of this study was to assess the long-term outcomes of patients with negative DBE and clarify the effect of repeat endoscopic work-up.
Methods:
A total of 42 patients with a negative DBE for overt obscure GI bleeding were enrolled, and their clinical data were retrospectively reviewed. The mean (± standard deviation) follow-up period is 5.4 (± 2.8) years. The outcome measurement was overt rebleeding witnessed by the patient after negative DBE. At the time of rebleeding, further endoscopic work-up and specific treatment were performed.
Results:
Rebleeding occurred in 16 of 42 patients (38%). At the time of rebleeding, further investigations were made in 14 of 16 patients (88%), and the bleeding source was identified in 10 of 14 patients (71%). These 10 patients received specific treatment (endoscopic in five, surgical in two, medical in two, and angiographic in one). The bleeding source was in the small intestine in seven of 10 patients (70%). Blood transfusion before DBE and multiple bleeding episodes before DBE were significant predictive factors for rebleeding (odds ratio 5.056, 95% confidence interval 1.158-22.059, p = 0.031 and odds ratio 8.167, 95% confidence interval 1.537-43.392, p = 0.014, respectively).
Conclusions:
The rebleeding rate after a negative DBE is considerable. Careful long-term follow-up and repeat endoscopic work-up at the time of overt rebleeding are important.
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