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Clinical Characteristics and Risk Factors for Rebleeding in Patients with Obscure Gastrointestinal Bleeding
Yuki Baba1, Seiji Kawano1, Yoshiyasu Kono1
1Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
Insights
Obscure gastrointestinal bleeding (OGIB) diagnosis and treatment have advanced with capsule endoscopy (CE) and double-balloon endoscopy (DBE). Patients with overt previous bleeding, vascular lesions, or chronic kidney disease face a higher risk of rebleeding.
Area of Science:
- Gastroenterology
- Endoscopy
- Internal Medicine
Background:
- Obscure gastrointestinal bleeding (OGIB) diagnosis and treatment have advanced with capsule endoscopy (CE) and double-balloon endoscopy (DBE).
- Rebleeding remains a challenge in managing OGIB, necessitating identification of associated risk factors.
- Understanding clinical features and risk factors for rebleeding is crucial for improved patient outcomes.
Purpose of the Study:
- To investigate the clinical features of obscure gastrointestinal bleeding (OGIB).
- To identify risk factors associated with rebleeding in patients with OGIB.
- To analyze data from patients undergoing CE and/or DBE for OGIB.
Main Methods:
- Retrospective study of 168 patients with small intestinal OGIB who underwent CE and/or DBE.
- Analysis of clinical characteristics, comorbidities, diagnoses, and rebleeding events.
- Univariate and multivariate analyses to identify risk factors for rebleeding.
Main Results:
- The mean age of patients was 64.5 years, with hypertension and chronic kidney disease as frequent comorbidities.
- Ulcerative and vascular lesions were common diagnoses, but the bleeding source remained undetermined in 47.0% of cases.
- Rebleeding occurred in 17.3% of patients, significantly associated with chronic kidney disease, vascular lesions, and overt previous bleeding.
Conclusions:
- Patients with OGIB presenting with overt previous bleeding, vascular lesions, or chronic kidney disease are at a higher risk of rebleeding.
- These findings aid in risk stratification and management strategies for OGIB.
- Further research may focus on targeted interventions for high-risk patient groups.
Abstract:
Objective With the advent of capsule endoscopy (CE) and double-balloon endoscopy (DBE), the diagnosis and treatment of obscure gastrointestinal bleeding (OGIB) have markedly progressed. However, rebleeding sometimes occurs and is difficult to diagnose and treat. The aim of the present study was to investigate the clinical features of OGIB and risk factors for rebleeding in our hospital. Methods A total of 195 patients who underwent CE and/or DBE for OGIB in our hospital from January 2009 to July 2016 were included in the present study. We analyzed 168 cases of small intestinal OGIB, after excluding 27 cases of extra small intestinal bleeding. The clinical characteristics and risk factors related to rebleeding were retrospectively studied. Results Among the 168 patients who were included in the analysis, 95 patients (56.5%) were male. The mean age was 64.5 years (range, 8 to 87 years). Hypertension (31.0%) was the most frequent comorbidity, followed by chronic kidney disease (19.0%). The final diagnoses were ulcerative lesions (n=50, 29.8%), vascular lesions (n=30, 17.9%), tumors (n=7, 4.2%), and diverticula (n=2, 1.2%). The bleeding source was undetermined in the remaining 79 cases (47.0%). Rebleeding was confirmed in 29 cases (17.3%). In a univariate analysis, chronic kidney disease, vascular lesions, and overt previous bleeding were significantly associated with the risk of rebleeding. A multivariate analysis showed that chronic kidney disease, vascular lesion, and overt previous bleeding were significantly associated with the risk of rebleeding. Conclusion Patients with OGIB with overt previous bleeding, vascular lesions, and/or chronic kidney disease had a higher risk of rebleeding.
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