Long-term outcome in patients with obscure gastrointestinal bleeding after negative capsule endoscopy

Koh, Seong‐Joon; Im, Jong Pil; Kim, Ji Won; Kim, Byeong Gwan; Lee, Kook Lae; Kim, Sang Gyun; Kim, Sang Woo; Jung, Hyun Chae

doi:10.3748/wjg.v19.i10.1632

Cited by 56 publications

(46 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Remarkably, the majority of re-bleeding episodes (81.3%) occurred within the first 2 years after VCE examination, while the cumulative risk of re-bleeding raised from 12.9% at 1, to 25.6% at 3 and to 31.5% at 5 years, respectively (31); this finding being verified by other authors (29). In keeping with the findings of previous reports (25,32), the median time until first rebleeding event was 15 months, underlying the value of patient monitoring for at least the first 2 years post negative VCE exam and perhaps later on, as the interquartile range for the time lag to re-bleeding was between 2 and 33 months (31).…”

Section: Re-bleeding Rate After Index Vce Small Bowel Examinationsupporting

confidence: 82%

“…Studies reporting very low re-bleeding rates had relative short follow-up (17,19,21,36,40,41). Contrariwise, Korean studies enrolled relatively more subjects with longer follow-up, exceeding 2 years (32,34,35,37). This possibly allowed Park et al (34) to display a re-bleeding rate of 35.7% during the 32 months follow-up, while Koh et al (32) showed that more than half of the patients suffered bleeding recurrence more than 1 year after the initial episode with the maximum time to re-bleeding being 24 months post-procedurally.…”

Section: Re-bleeding Rate After Index Vce Small Bowel Examinationmentioning

confidence: 99%

See 1 more Smart Citation

Long-term effects of video capsule endoscopy in the management of obscure gastrointestinal bleeding

et al. 2017

View full text Add to dashboard Cite

Obscure gastrointestinal bleeding (OGIB) accounts for approximately 5% of all gastrointestinal (GI) hemorrhages. It usually arises from a small bowel lesion beyond the reach of conventional endoscopy including esophagogastroduodenoscopy and colonoscopy. Video capsule endoscopy (VCE) revolutionized the evaluation of OGIB patients since it allows reliable and noninvasive visualization of the small bowel mucosal surface. Since 2001, VCE has evolved into an efficient technology integrated in clinical practice. It is the cornerstone in the algorithm of OGIB investigation given its high diagnostic yield, which compares favorably to that of double-balloon enteroscopy (DBE). In terms of outcomes, a positive index VCE examination usually correlates to a high re-bleeding rate, while a negative one provides adequate evidence of low re-bleeding risk, suggesting a wait and watch approach in this subset of patients. Additionally, a variety of factors has been acknowledged as significant predictors of re-bleeding episodes. While research data regarding immediate endoscopic findings have matured, data concerning the clinical utility of VCE in patients with OGIB on the long-term remain sparse. This manuscript reviews the current literature, aiming to highlight the role of VCE in the long-term management of OGIB.

show abstract

Section: Re-bleeding Rate After Index Vce Small Bowel Examinationsupporting

confidence: 82%

Section: Re-bleeding Rate After Index Vce Small Bowel Examinationmentioning

confidence: 99%

Long-term effects of video capsule endoscopy in the management of obscure gastrointestinal bleeding

et al. 2017

View full text Add to dashboard Cite

show abstract

“…In addition, 50-66% of patients have been reported to remain transfusion free without recurrent bleed at follow-up, aft er undergoing VCE-directed interventions ( 43,45 ). Th e rebleeding rate ranges from 6 to 27% in patients who have had a negative capsule study (46)(47)(48).…”

Section: Endoscopic Visualization Of the Small Intestinementioning

confidence: 96%

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Gerson

Fidler

Cave³

et al. 2015

American Journal of Gastroenterology

562

559

View full text Add to dashboard Cite

Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended for patients with initial negative small bowel evaluations and ongoing overt or occult bleeding.

show abstract

“…La recomendación actual es utilizar polietilenglicol (PEG) diluido en 2 litros de agua, bien sea como monoterapia o en combinación con simeticona, para garantizar una mejor calidad en la preparación y, por ende, una mayor rendimiento diagnóstico (27). Luego de dos horas de haber iniciado el estudio, el paciente puede tomar líquidos y, pasadas cinco horas, alimentarse normalmente (28).…”

Section: Videocápsula Endoscópica (Vce)unclassified

Sangrado del intestino delgado: enfoque y tratamiento

Sandoval-Riveros

Mindiola

Fernández

et al. 2017

Rev. Colomb. Gastroenterol.

View full text Add to dashboard Cite

Actualmente se pueden identificar lesiones del intestino delgado que antes eran inaccesibles. La principal herramienta diagnóstica es la videocápsula endoscópica por el alto valor predictivo negativo. Con los avances en los métodos endoscópicos, la clasificación de sangrado gastrointestinal ha cambiado. Es así como la definición de sangrado oscur,o que antes incluía al originado en intestino delgado, se ha relegado cuando su origen no se puede identificar tras la realización de esofagogastroduodenoscopia, colonoscopia y estudios del tracto digestivo medio, tales como videocápsula endoscópica, enteroscopia de empuje, enteroscopia profunda, enteroscopia intraoperatoria, enterorresonancia, enterotomografía, angiografía y gammagrafía.

show abstract

Long-term outcome in patients with obscure gastrointestinal bleeding after negative capsule endoscopy

Abstract: 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.

Cited by 56 publications

References 28 publications

Long-term effects of video capsule endoscopy in the management of obscure gastrointestinal bleeding

Long-term effects of video capsule endoscopy in the management of obscure gastrointestinal bleeding

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Sangrado del intestino delgado: enfoque y tratamiento

Contact Info

Product

Resources

About