Brief Article
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World J Gastroenterol. Mar 14, 2013; 19(10): 1632-1638
Published online Mar 14, 2013. doi: 10.3748/wjg.v19.i10.1632
Long-term outcome in patients with obscure gastrointestinal bleeding after negative capsule endoscopy
Seong-Joon Koh, Jong Pil Im, Ji Won Kim, Byeong Gwan Kim, Kook Lae Lee, Sang Gyun Kim, Joo Sung Kim, Hyun Chae Jung
Seong-Joon Koh, Ji Won Kim, Byeong Gwan Kim, Kook Lae Lee, Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul 110-744, South Korea
Jong Pil Im, Sang Gyun Kim, Joo Sung Kim, Hyun Chae Jung, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 110-744, South Korea
Author contributions: Koh SJ contributed to data collection and writing the manuscript; Im JP was in charge of this study; Kim JW, Kim BG, Lee KL, Kim SG, Kim JS and Jung HC contributed to data acquisition; all the authors have read and approved the final version of the manuscript.
Correspondence to: Jong Pil Im, MD, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul 110-744, South Korea. jp-im@hanmail.net
Telephone: +82-2-7408112 Fax: +82-2-7436701
Received: November 22, 2012
Revised: January 10, 2013
Accepted: January 18, 2013
Published online: March 14, 2013
Processing time: 111 Days and 21.5 Hours
Abstract

AIM: To investigate long-term outcome in obscure gastrointestinal bleeding (OGIB) after negative capsule endoscopy (CE) and identify risk factors for rebleeding.

METHODS: A total of 113 consecutive patients underwent CE for OGIB from May 2003 to June 2010 at Seoul National University Hospital. Ninety-five patients (84.1%) with a subsequent follow-up after CE of at least 6 mo were enrolled in this study. Follow-up data were obtained from the patients’ medical records. The CE images were reviewed by two board-certified gastroenterologists and consensus diagnosis was used in all cases. The primary outcome measure was the detection of rebleeding after CE, and factors associated with rebleeding were evaluated using multivariate analysis.

RESULTS: Of the 95 enrolled patients (median age 61 years, range 17-85 years), 62 patients (65.3%) were male. The median duration of follow-up was 23.7 mo (range 6.0-89.4 mo). Seventy-three patients (76.8%) underwent CE for obscure-overt bleeding. Complete examination of the small bowel was achieved in 77 cases (81.1%). Significant lesions were found in 38 patients (40.0%). The overall rebleeding rate was 28.4%. The rebleeding rate was higher in patients with positive CE (36.8%) than in those with negative CE (22.8%). However, there was no significant difference in cumulative rebleeding rates between the two groups (log rank test; P = 0.205). Anticoagulation after CE examination was an independent risk factor for rebleeding (hazard ratio, 5.019; 95%CI, 1.560-16.145; P = 0.007), regardless of CE results.

CONCLUSION: Patients with OGIB and negative CE have a potential risk of rebleeding. Therefore, close observation is required and alternative modalities should be considered in suspicious cases.

Keywords: Capsule endoscopy; Gastrointestinal hemorrhage; Risk factors; Prognosis; Enteroscopy