Brief Article
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World J Gastrointest Endosc. Nov 16, 2013; 5(11): 551-558
Published online Nov 16, 2013. doi: 10.4253/wjge.v5.i11.551
Outcome in obscure gastrointestinal bleeding after capsule endoscopy
Alex Cañas-Ventura, Lucia Márquez, Xavier Bessa, Josep Maria Dedeu, Marc Puigvehí, Sílvia Delgado-Aros, Ines Ana Ibáñez, Agustin Seoane, Luis Barranco, Felipe Bory, Montserrat Andreu, Begoña González-Suárez
Alex Cañas-Ventura, Lucia Márquez, Xavier Bessa, Josep Maria Dedeu, Marc Puigvehí, Sílvia Delgado-Aros, Ines Ana Ibáñez, Agustin Seoane, Luis Barranco, Felipe Bory, Montserrat Andreu, Department of Gastroenterology, Hospital del Mar Research Institute, Pompeu Fabra University, 08003 Barcelona, Spain
Begoña González-Suárez, Endoscopic Unit, Gastroenterology Department, ICMDiM. Hospital Clínic, 08036 Barcelona, Spain
Author contributions: Cañas-Ventura A, Marquez L and Gonzalez-Suarez B designed the study; Cañas-Ventura A, Marquez L, Bessa X, Dedeu JM, Puigvehi M, Delgado-Aros S, Ibañez IA, Seoane A, Barranco L, Andreu M, Bory F and Gonzalez-Suarez B performed the research; Cañas-Ventura A, Marquez L and Gonzalez-Suarez B analyzed the data; Cañas-Ventura A, Marquez L, Andreu M and Gonzalez-Suarez B wrote the paper; all authors have approved the final version to be published.
Correspondence to: Alex Cañas-Ventura, MD, Department of Gastroenterology, Hospital del Mar Research Institute, Pompeu Fabra University, Passeig Maritim 25, 08003 Barcelona, Spain. alexcanasventura@yahoo.es
Telephone: +34-93-2483217 Fax: +34-93-2218644
Received: April 13, 2013
Revised: July 1, 2013
Accepted: August 4, 2013
Published online: November 16, 2013
Processing time: 219 Days and 21.8 Hours
Abstract

AIM: To investigate the clinical impact of capsule endoscopy (CE) after an obscure gastrointestinal bleeding (OGIB) episode, focusing on diagnostic work-up, follow-up and predictive factors of rebleeding.

METHODS: Patients who were referred to Hospital del Mar (Barcelona, Spain) between 2007 and 2009 for OGIB who underwent a CE were retrospectively analyzed. Demographic data, current treatment with non-steroid anti-inflammtory drugs or anticoagulant drugs, hemoglobin levels, transfusion requirements, previous diagnostic tests for the bleeding episode, as well as CE findings (significant or non-significant), work-up and patient outcomes were analyzed from electronic charts. Variables were compared by χ2 analysis and Student t test. Risk factors of rebleeding were assessed by Log-rank test, Kaplan-Meier curves and Cox regression model.

RESULTS: There were 105 patients [45.7% women, median age of 72 years old (interquartile range 56-79)] and a median follow-up of 326 d (interquartile range 123-641) included in this study. The overall diagnostic yield of CE was 58.1% (55.2% and 63.2%, for patients with occult OGIB and overt OGIB, respectively). In 73 patients (69.5%), OGIB was resolved. Multivariate analysis showed that hemoglobin levels lower than 8 g/dL at diagnosis [hazard ratios (HR) = 2.7, 95%CI: 1.9-6.3], patients aged 70 years and above (HR = 2.1, 95%CI: 1.2-6.1) and significant findings in CE (HR = 2.4, 95%CI: 1.1-5.8) were independent predictors of rebleeding.

CONCLUSION: One third of the patients presented with rebleeding after CE; risk factors were hemoglobin levels < 8 g/dL, age ≥ 70 years or the presence of significant lesions.

Keywords: Capsule endoscopy; Obscure gastrointestinal bleeding; Small bowel; Angiodysplasia; Enteroscopy

Core tip: This paper describes a large cohort of patients with obscure gastrointestinal bleeding who underwent a capsule endoscopy. The diagnostic yield was analyzed with further exploration motivated by the capsule findings, as well as the outcome during follow-up. Risk factors of rebleeding were also analyzed. Interestingly, old age, a lower hemoglobin level at diagnosis and significant lesions in capsule endoscopy were found to be predictors of rebleeding in this cohort.