Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2018; 10(10): 301-307
Published online Oct 16, 2018. doi: 10.4253/wjge.v10.i10.301
Yield of capsule endoscopy in obscure gastrointestinal bleeding: A comparative study between premenopausal and menopausal women
João Carlos Silva, Rolando Pinho, Adélia Rodrigues, Ana Ponte, Jaime Pereira Rodrigues, Mafalda Sousa, Catarina Gomes, João Carvalho
João Carlos Silva, Rolando Pinho, Adélia Rodrigues, Ana Ponte, Jaime Pereira Rodrigues, Mafalda Sousa, Catarina Gomes, João Carvalho, Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto 4434-502, Portugal
Author contributions: Silva JC and Pinho R designed the study, performed the research, analyzed the data and wrote the paper; Rodrigues A, Ponte A, Rodrigues JP, Sousa M, Gomes C and Carvalho J performed the research and analyzed the data.
Institutional review board statement: The study was reviewed and approved by the review board of Centro Hospital de Vila Nova de Gaia/Espinho.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interest for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: João Carlos Silva, MD, Doctor, Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, Vila Nova de Gaia, Porto 4434-502, Portugal. joaocarosilva@gmail.com
Telephone: +351-22-7865100 Fax: +351-22-7868369
Received: April 30, 2018
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
Abstract
AIM

To evaluate differences in capsule endoscopy (CE) performed in the setting of obscure gastrointestinal bleeding (OGIB) among premenopausal women (PMW) and menopausal women (MW).

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Keywords: Diagnostic yield; Obscure gastrointestinal bleeding; Premenopausal women; Menopausal women; Capsule endoscopy

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.