Published online Apr 10, 2016. doi: 10.4253/wjge.v8.i7.344
Peer-review started: June 20, 2015
First decision: July 27, 2015
Revised: October 12, 2015
Accepted: January 27, 2016
Article in press: January 29, 2016
Published online: April 10, 2016
Processing time: 291 Days and 4.8 Hours
AIM: To assess the clinical impact of capsule endoscopy (CE) in the long-term follow-up period in patients with obscure gastrointestinal bleeding (OGIB).
METHODS: One hundred and forty-one patients who applied CE for OGIB between 2009 and 2012 were retrospectively analyzed, and this cohort was then questioned prospectively. Demographic data of the patients were determined via the presence of comorbid diseases, use of non-steroidal anti-inflammatory drugs anticoagulant-antiaggregant agents, previous diagnostic tests for bleeding episodes, CE findings, laboratory tests and outcomes.
RESULTS: CE was performed on 141 patients because of OGIB. The capsule was retained in the upper gastrointestinal (GI) system in two of the patients, thus video monitoring was not achieved. There were 139 patients [62% male, median age: 72 years (range: 13-93 years) and a median follow-up duration: 32 mo (range: 6-82 mo)]. The overall diagnostic yield of CE was 84.9%. Rebleeding was determined in 40.3% (56/139) of the patients. The rebleeding rates of patients with positive and negative capsule results at the end of the follow-up were 46.6% (55/118) and 4.8% (1/21), respectively. In the multivariate analysis, usage of NSAIDs, anticoagulant-antiaggregant therapies (OR = 5.8; 95%CI: 1.86-18.27) and vascular ectasia (OR = 6.02; 95%CI: 2.568-14.146) in CE were detected as independent predictors of rebleeding. In the univariate analysis, advanced age, comorbidity, and overt bleeding were detected as predictors of rebleeding.
CONCLUSION: CE is a reliable method in the diagnosis of obscure GI bleeding. Negative CE correlated with a significantly lower rebleeding risk in the long-term follow-up period.
Core tip: This study determines the results of using capsule endoscopy in obscure gastrointestinal bleeding in long-term. Our main aim was to describe the long-term clinical impact of capsule endoscopy during follow-up period. Positive capsule endoscopy results correlated with higher rebleeding rates. Independent predictors of rebleeding were detected to be usage of non-steroidal anti-inflammatory drugs, anticoagulant/antiaggregant therapy and vascular ectasia.