Impact of the timing of capsule endoscopy in overt obscure gastrointestinal bleeding on yield and rebleeding rate - is sooner than 14 d advisable?

doi:10.4253/wjge.v10.i4.74

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World Journal of Gastrointestinal Endoscopy

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1948-5190

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Endosc. Apr 16, 2018; 10(4): 74-82
Published online Apr 16, 2018. doi: 10.4253/wjge.v10.i4.74

Table 1 Patient characteristics n (%)

No. of patients (n = 115)	All	≤ 48 h(n = 39, 33.9)	48 h-14 d(n = 35, 30.4)	≥ 14 d(n = 41, 35.7)	P value¹
Time to CE after OOGIB, mean ± SD, d	48.9 ± 161.5
Age, mean ± SD, yr	65.1 ± 14.6	63 ± 14.2	63.9 ± 15.9	68.2 ± 13.6	0.234
Female sex	59 (51.3)	18 (46.2)	20 (57.1)	21 (51.2)	0.64
Comorbidities
Cardiovascular disease	61 (53)	20 (51.3)	16 (45.7)	25 (61)	0.40
Renal disease	20 (17.4)	2 (5.1)	8 (22.9)	10 (24.4)	0.045
Hepatic disease	8 (7)	3 (7.7)	2 (5.7)	3 (7.3)	0.940
Tumour	7 (6.1)	2 (5.1)	2 (5.7)	3 (7.3)	0.91
Previous abdominal surgeries	27 (23.5)	10 (25.6)	8 (22.9)	9 (22)	0.92
Drugs
Anti-platelet drugs	49 (42.6)	17 (43.6)	13 (37.1)	19 (46.3)	0.71
Anticoagulation	25 (21.7)	8 (20.5)	9 (25.7)	8 (19.5)	0.79
NSAIDs	10 (8.7)	4 (10.3)	2 (5.7)	4 (9.8)	0.75
Melena	63 (54.8)	18 (46.2)	21 (60)	24 (58.5)	0.41
Hematochezia	52 (45.2)	21 (53.8)	14 (40)	17 (41.5)	0.41
On-going OOGIB	62 (53.9)	39 (100)	17 (48.6)	6 (14.6)	< 0.001
Hg at admission, mean ± SD, g/dL	8.91 ± 6.24	8.51 ± 2.65	8.26 ± 2.32	9.93 ± 9.88	0.12
INR at admission, mean ± SD	1.61 ± 1.18	1.57 ± 1.00	1.83 ± 1.65	1.47 ± 0.77	0.08
Packed RBC transfusions, mean ± SD, units	1.41 ± 1.31	1.41 ± 1.37	1.51 ± 1.20	1.29 ± 1.36	0.29
Inpatient	78 (67.8)	39 (100)	31 (88.6)	8 (19.5)	< 0.001

¹ANOVA, χ² test, as appropriate; P value of 0.05 indicating statistical significance. CE: Capsule endoscopy; SD: Standard deviations; NSAIDs: Nonsteroidal anti-inflammatory drug; OOGIB: Overt-obscure gastrointestinal bleeding; Hg: Hemoglobin; INR: International normalized ratio; RBC: Red blood cells.

Table 2 Patient characteristics according to the system of capsule endoscopy used n (%)

No. of patients (n = 115)	All	Given^® (n = 32, 27.8)	Mirocam^® (n = 83, 72.2)	P value¹
Time to CE after OOGIB, mean ± SD, d	48.9 ± 161.5	51 ± 119.1	48.1 ± 175.8	0.93
Age, mean ± SD, yr	65.1 ± 14.6	60.8 ± 16.9	66.8 ± 13.3	0.08
Female sex	59 (51.3)	18 (56.2)	41 (49.4)	0.51
Comorbidities
Cardiovascular disease	61 (53)	15 (46.9)	46 (55.4)	0.41
Renal disease	20 (17.4)	3 (9)	17 (20.5)	0.16
Hepatic disease	8 (7)	2 (6)	6 (7)	0.85
Tumour	7 (6.1)	1 (3)	6 (7)	0.41
Previous abdominal surgeries	27 (23.5)	5 (16)	22 (26.5)	0.22
Drugs
Anti-platelet drugs	49 (42.6)	12 (37.5)	37 (44.6)	0.49
Anticoagulation	25 (21.7)	7 (21.9)	18 (21.7)	0.98
NSAIDs	10 (8.7)	4 (12.5)	6 (7)	0.37
Melena	63 (54.8)	21 (65.6)	42 (50.6)	0.15
Hematochezia	52 (45.2)	11 (34.4)	41 (49.4)	0.15
On-going OOGIB	62 (53.9)	7 (21.9)	55 (66.3)	< 0.001
Hg at admission, mean ± SD, g/dL	8.91 ± 6.24	8.94 ± 2.77	8.94 ± 7.14	0.99
INR at admission, mean ± SD	1.61 ± 1.18	1.55 ± 0.81	1.64 ± 1.29	0.72
Packed RBC transfusions, mean ± SD, units	1.41 ± 1.31	1.28 ± 1.42	1.45 ± 1.27	0.55
Inpatient	78 (67.8)	18 (56.2)	60 (72.3)	0.01
Timing of CE
≤ 48 h	39 (33.9)	4 (12.5)	35 (42.2)	0.009
48 h-14 d	35 (30.4)	14 (43.75)	21 (25.3)
≥ 14 d	41 (35.7)	14 (43.75)	27 (32.5)

¹t-test: χ² test, as appropriate; P value of 0.05 indicating statistical significance. CE: Capsule endoscopy; SD: Standard deviations; NSAIDs: Nonsteroidal anti-inflammatory drug; OOGIB: Overt-obscure gastrointestinal bleeding; Hg: Hemoglobin; INR: International normalized ratio; RBC: Red blood cells.

Table 3 Capsule endoscopy findings in all patients and between ≤ 48 h, 48 h-14 d and ≥ 14 d group n (%)

	All (n = 115)	≤ 48 h (n = 39)	48 h-14 d (n = 35)	≥ 14 d (n = 41)	P value¹
Total enteroscopy	104 (90.4)	33 (84.6)	32 (91.4)	39 (95.1)	0.27
Appropriate cleansing	87 (75.7)	21 (53.8)	31 (88.6)	35 (85.4)	0.00
Positive Findings	94 (81.8)	33 (84.3)	31 (88.6)	31 (75.6)	0.30
Angiodysplasia	30 (26.1)	6 (15.4)	11 (31.4)	13 (31.7)
Varices	1 (0.9)	0	1 (2.9)	0
Hemangioma	3 (2.6)	1 (2.6)	1 (2.9)	1 (2.4)
Ulcers	12 (10.4)	3 (7.7)	5 (14.3)	4 (9,8)
Erosions	7 (6)	1 (2.6)	1 (2.9)	5 (12.2)
Tumours	11 (9.6)	2 (5.1)	7 (20)	2 (4.9)
Polyps	4 (3.5)	1 (2.6)	2 (5.7)	1 (2.4)
Diverticula	2 (1.7)	1 (2.6)	0	1 (2.4)
Extra-SB cause	2 (1.7)	2 (5.1)	0	0
Bleeding	48 (41.7)	23 (59)	15 (42.9)	10 (24.4)	0.007
Inactive bleeding	13 (11.3)	6 (15.4)	5 (14.3)	2 (4.9)	0.27
Active bleeding	35 (30.4)	17 (43.6)	10 (28.6)	8 (19.5)	0.06

¹χ² test; P value of 0.05 indicating statistical significance. CE: Capsule endoscopy.

Table 4 Capsule endoscopy outcomes in all patients, and between ≤ 48 h, 48h-14 d and ≥ 14 d groups n (%)

Outcome	All (n = 115)	≤ 48 h (n = 39)	48 h-14 d (n = 35)	≥ 14 d (n = 41)	P value¹	P¹ (≤ 48 h vs 48 h-14 d)
DY	92 (80)	32 (82.1)	30 (85.7)	30 (73.2)	0.37	0.67
TY	53 (46.1)	26 (66.7)	14 (40)	13 (31.7)	0.005	0.02
RR	37 (32.2)	6 (15.4)	12 (34.3)	19 (46.3)	0.007	0.06
Time to rebleed, yr	1 yr, 17.8	1 yr, 11.8	1 yr, 20.1	1 yr, 21.9
	2 yr, 24.1	2 yr, 11.8	2 yr, 30.7	2 yr, 31.4
	3 yr, 33.9	3 yr, 18.5	3 yr, 37	3 yr, 46.9
	4 yr, 30.8	4 yr, 18.5	4 yr, 44	4 yr, 58.2
	5 yr, 52.6	5 yr, 60	5 yr, 53.4	5 yr, 64.2
Mortality	28 (24.3)	9 (23.1)	10 (28.6)	9 (22)	0.78	0.59

¹χ² test; P value of 0.05 indicating statistical significance. DY: Diagnostic yield; TY: Therapeutic yield; RR: Rebleeding rate.

Table 5 Type of treatment between ≤ 48 h, 48 h-14 d and ≥ 14 d groups n (%)

Type of treatment	All (n = 115)	≤ 48 h (n = 39)	48 h-14 d (n = 35)	≥ 14 d (n = 41)	P value¹
Conservative	62 (53.9)	13 (33.3)	21 (60)	28 (68.3)	0.005
Endoscopic	30 (26.1)	14 (35.9)	6 (17.1)	10 (24.4)	0.18
Surgical	19 (16.5)	9 (23.1)	7 (20)	3 (7.3)	0.13
Radiological	3 (2.6)	2 (5.1)	1 (2.9)	0	0.353
Endoscopic + Surgical	1 (0.9)	1 (2.6)	0	0	0.37

¹χ² test; P value of 0.05 indicating statistical significance.

Table 6 Outcomes between ≤ 48 h and > 48 h groups and < 14 d and ≥ 14 d groups

Outcome	≤ 48 h	> 48 h	P¹ (≤ 48 h vs > 48h)	< 14 d	≥ 14 d	P¹ (< 14 d vs ≥ 14 d)
DY	32 (82.1)	60 (78.9)	0.69	62 (83.8)	30 (73.2)	0.17
TY	26 (66.7)	27 (35.5)	0.002	40 (54.1)	13 (31.7)	0.02
RR	6 (15.4)	31 (43)	0.004	18 (25)	19 (46.3)	0.008
Time to re-bleed, yr	1 yr, 11.8	1 yr, 1		1 yr, 15.6	1 yr, 21.9
	2 yr, 11.8	2 yr, 31.1		2 yr, 20.4	2 yr, 31.4
	3 yr, 18.5	3 yr, 42.6		3 yr, 26.8	3 yr, 46.9
	4 yr, 18.5	4 yr, 52		4 yr, 30.6	4 yr, 58.2
	5 yr, 60	5 yr, 59.7		5 yr, 38.3	5 yr, 64.2
Mortality	9 (23.1)	19 (25)	0.82	19 (25.7)	9 (22)	0.66

¹χ² test; P value of 0.05 indicating statistical significance. DY: Diagnostic yield; TY: Therapeutic yield; RR: Re-bleeding rate.

Citation: Gomes C, Pinho R, Rodrigues A, Ponte A, Silva J, Rodrigues JP, Sousa M, Silva JC, Carvalho J. Impact of the timing of capsule endoscopy in overt obscure gastrointestinal bleeding on yield and rebleeding rate - is sooner than 14 d advisable? World J Gastrointest Endosc 2018; 10(4): 74-82
URL: https://www.wjgnet.com/1948-5190/full/v10/i4/74.htm
DOI: https://dx.doi.org/10.4253/wjge.v10.i4.74