Published online Oct 16, 2018. doi: 10.4253/wjge.v10.i10.301
Peer-review started: April 30, 2018
First decision: June 6, 2018
Revised: July 6, 2018
Accepted: August 1, 2018
Article in press: August 1, 2018
Published online: October 16, 2018
Processing time: 83 Days and 3.5 Hours
To evaluate differences in capsule endoscopy (CE) performed in the setting of obscure gastrointestinal bleeding (OGIB) among premenopausal women (PMW) and menopausal women (MW).
Retrospective, single-center study, including female patients submitted to CE in the setting of OGIB between May 2011 and December 2016. Patients were divided into 2 groups according to age, considering fertile age as ≤ 55 years and postmenopausal age as > 55 years. The diagnostic yield (DY), the rebleeding rate and the time to rebleed were evaluated and compared between groups. Rebleeding was defined as a drop of Hb > 2 g/dL or need for transfusional support or presence of melena/hematochezia.
A hundred and eighty three female patients underwent CE for OGIB, of whom 30.6% (n = 56) were PMW and 69.4% (n = 127) were MW. The DY was 30.4% in PMW and 63.8% in MW. The most common findings were angiodysplasias in both groups (PMW: 21.4%, MW: 44.9%) (P = 0.003). In PMW, only 1.8% required therapeutic endoscopy. In 17.3% of MW, CE findings led to additional endoscopic treatment. Rebleeding at 1, 3 and 5 years in PMW was 3.6%, 10.2%, 10.2% and 22.0%, 32.3% and 34.2% in MW. Postmenopausal status was significantly associated with higher DY (P < 0.001), TY (P = 0.003), rebleeding (P = 0.031) and lower time to rebleed (P = 0.001).
PMW with suspected OGIB are less likely to have significant findings in CE. In MW DY, need for endoscopic treatment and rebleeding were significantly higher while time to rebleed was lower.
Core tip: Patients with negative findings in oesophagogastroduodenoscopy and colonoscopy with suspected obscure gastrointestinal-bleeding benefit from further capsule endoscopy (CE) study. Premenopausal women are frequently referred for CE. However in this subset of patients the pretest probability of positive findings is thought to be low. This paper compared the diagnostic yield (DY) as well as therapeutic yield (TY), rebleeding, hospitalization and mortality between premenopausal and menopausal women. We found that menopause status was significantly associated with positive findings, DY, TY, rebleeding and lower time to rebleed. This may lead to consider the exclusion of other comorbid pathologies in fertile age women before CE.