Brief Article
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World J Gastroenterol. Jul 28, 2013; 19(28): 4520-4525
Published online Jul 28, 2013. doi: 10.3748/wjg.v19.i28.4520
Negative capsule endoscopy in patients with obscure gastrointestinal bleeding reliable: Recurrence of bleeding on long-term follow-up
Maria Elena Riccioni, Riccardo Urgesi, Rossella Cianci, Gianluca Rizzo, Luca D’Angelo, Riccardo Marmo, Guido Costamagna
Maria Elena Riccioni, Guido Costamagna, Digestive Endoscopy Unit, Catholic University of Rome, 00168 Rome, Italy
Riccardo Urgesi, Gastroenterology and Digestive Endoscopy Unit, Ospedale Belcolle, 01100 Viterbo, Italy
Rossella Cianci, Department of Internal Medicine, Catholic University of Rome, 00168 Rome, Italy
Gianluca Rizzo, Department of Surgery, Catholic University of Rome, 00168 Rome, Italy
Luca D’Angelo, Department of Neurosurgery, Ospedale Belcolle, 01100 Viterbo, Italy
Riccardo Marmo, Gastroenterology Unit, Ospedale di Polla, 84035 Polla, Salerno, Italy
Author contributions: Riccioni ME designed research; Urgesi R and Cianci R performed research; Rizzo G and Marmo R analyzed data; Riccioni ME, Cianci R, Urgesi R and D’Angelo L wrote the paper; Costamagna G revised the manuscript.
Correspondence to: Dr. Riccardo Urgesi, Gastroenterology and Digestive Endoscopy Unit, Ospedale Belcolle, Via Sammartinese, 01100 Viterbo, Italy. riurgesi@tin.it
Telephone: +39-6-30156580 Fax: +39-6-30156581
Received: February 15, 2013
Revised: April 11, 2013
Accepted: May 16, 2013
Published online: July 28, 2013
Processing time: 164 Days and 8.4 Hours
Abstract

AIM: To assess the rate of recurrent bleeding of the small bowel in patients with obscure bleeding already undergone capsule endoscopy (CE) with negative results.

METHODS: We reviewed the medical records related to 696 consecutive CE performed from December 2002 to January 2011, focusing our attention on patients with recurrence of obscure bleeding and negative CE. Evaluating the patient follow-up, we analyzed the recurrence rate of obscure bleeding in patient with a negative CE. Actuarial rates of rebleeding during follow-up were calculated, and factors associated with rebleeding were assessed through an univariate and multivariate analysis. A P value of less than 0.05 was regarded as statistically significant. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of negative CE were calculated.

RESULTS: Two hundred and seven out of 696 (29.7%) CE studies resulted negative in patient with obscure/overt gastrointestinal bleeding. Overall, 489 CE (70.2%) were positive studies. The median follow-up was 24 mo (range 12-36 mo). During follow-up, recurrence of obscure bleeding was observed only in 34 out of 207 negative CE patients (16.4%); 26 out of 34 with obscure overt bleeding and 8 out of 34 with obscure occult bleeding. The younger age (< 65 years) and the onset of bleeding such as melena are independent risk factors of rebleeding after a negative CE (OR = 2.6703, 95%CI: 1.1651-6.1202, P = 0.0203; OR 4.7718, 95%CI: 1.9739-11.5350, P = 0.0005). The rebleeding rate (CE+ vs CE-) was 16.4% vs 45.1% (χ2 test, P = 0.00001). The sensitivity, specificity, and PPV and NPV were 93.8%, 100%, 100%, 80.1%, respectively.

CONCLUSION: Patients with obscure gastrointestinal bleeding and negative CE had a significantly lower rebleeding rate, and further invasive investigations can be deferred.

Keywords: Capsule endoscopy; Enteroscopy; Anemia; Obscure gastrointestinal bleeding; Rebleeding

Core tip: Although capsule endoscopy (CE) is widely used as a first-line diagnostic modality for obscure gastrointestinal bleeding after the execution of a work-out negative for gastrointestinal bleeding properly done by following the guidelines proposed by American Gas Association, the rebleeding rate after negative CE varies according to different studies. We tried to elucidate the outcomes after a negative CE for obscure gastrointestinal bleeding (OGIB) and to determine the risk factors associated with rebleeding. Based on the results of our study patients with OGIB and negative CE had a significantly lower rebleeding rate, and further invasive investigations can be deferred.