Risk factors for small bowel bleeding in an overt gastrointestinal bleeding presentation after negative upper and...

Area of Science:

• Gastroenterology
• Diagnostic Endoscopy
• Small Bowel Imaging

Background:

• Overt gastrointestinal (GI) bleeding often necessitates further investigation when initial upper and lower endoscopies are inconclusive.
• Video capsule endoscopy (VCE) is the standard for diagnosing small bowel bleeding (SBB) sources.
• Predictive factors for positive VCE in overt bleeding cases remain unclear.

Purpose of the Study:

• To identify clinical and endoscopic predictors of a positive VCE in patients with overt GI bleeding and suspected small bowel source.
• To determine factors associated with successful therapeutic intervention following VCE.

Main Methods:

• Retrospective analysis of 117 inpatient VCE procedures for melena or hematochezia.
• Inclusion criteria: prior esophagogastroduodenoscopy (EGD) and colonoscopy.
• Data collected: demographics, medications, endoscopic findings; VCE graded using P0-P2 system.

Main Results:

• A positive VCE (P2) occurred in 29.9% of cases.
• Blood in the terminal ileum on VCE was a significant predictor of a positive VCE (OR: 6.13) and therapeutic intervention (OR: 5.04).
• Presence of diverticula on colonoscopy was inversely associated with a positive VCE in univariate analysis.

Conclusions:

• Terminal ileum visualization of blood is a strong indicator of small bowel bleeding and predicts therapeutic intervention.
• Diverticula identified during colonoscopy may be inversely associated with positive VCE findings.