Re-bleeding events in patients with obscure gastrointestinal bleeding after negative capsule endoscopy

Table 1 Clinical characteristics of patients with obscure gastrointestinal bleeding and a negative capsule endoscopy (n = 113)

	% (n)
Age
≤ 65 years old	37.2 (42)
> 65 years old	62.8 (71)
Gender
Female	64.6 (73)
Male	35.4 (40)
Comorbidities
Chronic kidney disease	12.4 (14)
Aortic stenosis	6.3 (7)
Prior angiodysplasia	3.5 (4)
Medication
None relevant	54 (61)
Single anti-platelet agent	16.8 (19)
Anticoagulant	7.1 (8)
NSAID	7.1 (8)
Double anti-platelet agent	5.3 (6)
SSRI	3.5 (4)
Occult OGIB	69 (78)
Iron deficiency anemia	63 (71)
Overt OGIB	31 (35)
Melena	19.5 (22)
Hematochezia	11.5 (13)
[Hb] prior to WCE (median; IQR; g/L)	86 (70-100)
Transfusional needs prior to WCE (RBC units; median; IQR)	1 (1-2)
Technical Issues
Gastric Transit Time (min; median; IQR)	18 (11-37)
Small-bowel Transit Time (min; median; IQR)	253 (216-323)
WCE per Examiner (%)
Person A	42.5 (n = 48)
Person B	38.9 (n = 44)
Person C	9.7 (n = 11)
Person D	8.9 (n = 10)

NSAID: Non-steroidal anti-inflammatory drugs; SSRI: Selective serotonin reuptake inhibitor; OGIB: Obscure gastrointestinal bleeding; [Hb]: Serum hemoglobin; WCE: Wireless capsule endoscopy; IQR: Interquartile range; RBC: Red blood cells.

Table 2 Characteristics of patients with a negative capsule endoscopy

Variable	All	Non re-bleeders	Re-bleeders	P
Age (years old)	67 ± 15	65 ± 15	72 ± 11	0.007
Gender (M/F)	40/73	27/55	13/18	0.386
OGIB presentation (n)
Occult	79	61	18	0.067
Overt	34	21	13
[Hb] (median)	86	86	79	0.143
Anticoagulant use (n)	11	4	7	0.009
Small-bowel Transit time (median)	253	253.5	251.5	0.650

Values are presented in mean ± SD unless stated otherwise. M/F: Male/female; OGIB: Obscure gastrointestinal bleeding; [Hb]: Serum hemoglobin.

Table 3 Univariate and Multivariate analysis via Cox proportional hazard regression model: Re-bleeding risk factors in patients with obscure gastrointestinal bleeding and a negative capsule endoscopy

Variables	Univariate analysis			Multivariate analysis
	HR	95%CI	P	HR	95%CI	P
Female	1.408	0.676-2.929	0.361
Age > 65 years old	3.599	1.364-9.501	0.010	2.591	0.951-7.060	0.063
Chronic kidney disease	3.498	1.265-9.671	0.016	2.252	0.749-6.770	0.148
Aortic stenosis	4.159	1.412-12.247	0.010	1.548	0.352-6.811	0.563
Prior angiodysplasia	3.637	0.851-15.457	0.081
Bleeding-related drugs	1.586	0.761-3.304	0.219
Anticoagulant use	3.903	1.542-9.875	0.004	2.699	0.705-10.330	0.147
Overt OGIB	2.104	1.011-4.380	0.047	1.986	0.933-4.231	0.075
[Hb] < 80 g/L	1.857	0.868-3.970	0.111
Transfusional (RBC) needs prior to WCE	1.122	0.919-1.370	0.257

Values are presented in mean ± SD unless stated otherwise. HR: Hazard ratio; OGIB: Obscure gastrointestinal bleeding; [Hb]: Serum hemoglobin; RBC: Red blood cells; WCE: Wireless capsule endoscopy.

Table 4 Comparison between patients presenting with occult/overt obscure gastrointestinal bleeding

Variable	Occult OGIB	Overt OGIB	P
Age (years old)	66	68	0.448
Sex (M/F)	24/54	16/19	0.141
[Hb] (median)	8.9	7.9	0.015
Anticoagulant use (n)	8	3	1.000
Time from OGIB to WCE (d; median)	31	29	0.653
Follow-up period (mo; median)	48	42	0.450
Rebleeding cumulative events (at 12 mo) (n)	9% (7)	21% (7)	0.133
Rebleeding cumulative events (at 36 mo) (n)	20% (13)	39% (11)
Rebleeding cumulative events (at 60 mo) (n)	29% (16)	39% (11)
Rebleeding cumulative events (at 84 mo) (n)	34% (17)	49% (12)
Rebleeding cumulative events (total) (n)	17	12
Time to rebleeding event (mo; IQR)	22 (6-33)	8.5 (0.5-27)	0.257

Values are presented in mean ± SD unless stated otherwise. OGIB: Obscure gastrointestinal bleeding; M/F: Male/female; [Hb]: Serum hemoglobin; IQR: Interquartile range.