Long-Term Prognosis of Patients with Obscure Gastrointestinal Bleeding: A Retrospective Cohort Study

Arai, Makoto; Matsumura, Tomoaki; Ohta, Yuki; Kiyono, Soichiro; Hayashi, Masahiro; Taida, Takashi; Saito, Keiko; Okimoto, Kenichiro; Maruoka, Daisuke; Nakagawa, Tomoo; Katsuno, Tatsuro; Kato, Naoya; Takiguchi, Yuichi

doi:10.1159/000493854

Cited by 4 publications

(3 citation statements)

References 23 publications

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“…The rate of patients with occult OGIB was reported as 20.4%–41.4%. 19 , 20 , 21 , 22 This study's rate of occult bleeding was approximately 60%, higher than that in previous reports. We reported that the detection rate of the bleeding source for patients with occult OGIB was 27%.…”

Section: Discussioncontrasting

confidence: 61%

Clinical usefulness and acceptability of small‐bowel capsule endoscopy with panoramic imaging compared with axial imaging in Japanese patients

Hirata,

Tsuboi,

Matsubara

et al. 2024

DEN Open

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ObjectivesWe aimed to evaluate the usefulness and acceptability of CapsoCam Plus (CapsoCam) in Japanese patients.MethodsThis retrospective single‐center study enrolled 930 patients with suspected small‐bowel bleeding (SSBB) who underwent capsule endoscopy. Thirty‐three patients using CapsoCam and PillCam SB3 (SB3) were matched using propensity score matching. The diagnostic yield and the acceptability of CapsoCam were evaluated.ResultsThere was no SSBB case where capsule endoscopy was performed within 48 h of bleeding. CapsoCam had a significantly higher observation rate of the entire small bowel (97% vs. 73%, p = 0.006) and Vater's papilla (82% vs. 15%, p < 0.001) than SB3. The reading time of CapsoCam was significantly longer than that of SB3 (30 vs. 25 min, p < 0.001), and CapsoCam's time from the capsule endoscopy swallowing to read completion was longer than that of SB3 (37 vs. 12 h, p < 0.001). The two groups showed no difference in the capsule endoscopy findings according to the P classification. Notably, 85% of the patients using CapsoCam reported examination distress as “not at all” or “almost not,” and 94% reported swallowing difficulty as “very easy” or “easy.”ConclusionsCapsoCam took time to read; however, it is a well‐tolerated examination with a high observation rate of Vater's papilla and entire small‐bowel mucosa. Detectability of bleeding sources was comparable in both modalities for cases of occult SSBB and overt SSBB more than 48 h after bleeding. CapsoCam is a useful modality for patients with SSBB.

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Section: Discussioncontrasting

confidence: 61%

Clinical usefulness and acceptability of small‐bowel capsule endoscopy with panoramic imaging compared with axial imaging in Japanese patients

Hirata,

Tsuboi,

Matsubara

et al. 2024

DEN Open

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“…This is comparable to the 5-year mortality rate seen when SB adenocarcinoma (all SEER stages combined) is diagnosed (68 %) and worse than when the cancer is localised (85 % survival at 5 years) [7]. A similar study looking at all causes of occult SB bleeding had a 74.7 % 5-year survival rate compared to 89.3 % age matched cohort survival in Japan [8]. This would suggest that a diagnosis of SB angioectasia is both significant and associated with worse outcomes than serious alternative pathologies seen.…”

Section: Discussionmentioning

confidence: 55%

Small bowel angioectasia as a marker of frailty and poor prognosis

et al. 2020

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Background and study aims This study aimed to establish 5-year survival of patients diagnosed with bleeding small bowel (SB) angioectasia, with the hypothesis that many will suffer deaths relating to comorbidity rather than gastrointestinaI bleeding. Patients and methods SB capsule endoscopy (SBCE) procedures, performed for suspected SB bleeding or iron deficiency anemia, with angioectasia isolated as the cause of SB bleeding and at least 5 years of follow-up data were isolated (n = 125) along with an age-matched group with “normal” SBCE procedures (n = 125). These were retrospectively analysed with further information on mortality and comorbidity gathered through hospital records. Results Those with angioectasia had a median age of 72.7 years and comorbidities were common. The 5-year survival was 64.0 % (80/125) compared to 70.4 % (88/125) in those with “normal” SBCE. Those with significant cardiac or vascular comorbidity had a poorer survival (52.9 % (37/70) at 5 years) but anticoagulation/antiplatelets/ number of lesions or requirement endoscopic treatment seemed to make little difference. In those with SB bleeding secondary to angioectasia none of the subsequent deaths were directly attributable to gastrointestinal bleeding. Conclusions In this cohort, SB angioectasia did not lead to any deaths but the 5-year survival was poor due to those diagnosed often being older and having comorbidities. This would support the hypothesis that a diagnosis of SB bleeding secondary to angioectasia suggests frailty.

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“…The MGIB is a topic of great interest in the gastroenterology practice, being a vastly studied matter, concerning areas such as diagnostic approach, prognosis, treatment and surveillance 1,23,24 . Several factors have been established as potentially influencing the rate of rebleeding 25 ; however, we lack specific knowledge on how to optimize the interpretation of these risk factors to establish the optimal surveillance of MGIB patients.…”

Section: Discussionmentioning

confidence: 99%

RHEMITT score: Predicting the risk of mid gastrointestinal rebleeding after small bowel capsule endoscopy: A prospective validation

Magalhães

Sousa‐Pinto

Carvalho

et al. 2021

J of Gastro and Hepatol

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Background and Aim The RHEMITT score (Renal disease; Heart failure; Endoscopic findings; Major bleeding; Incomplete SBCE; Tobacco; Treatment by enteroscopy) was the first score to accurately predict the individual risk of small bowel rebleeding after capsule endoscopy (SBCE). The aim of the study is on the prospective validation of the RHEMITT score. Methods Cohort of consecutive patients with mid‐gastrointestinal bleeding (MGIB) submitted to SBCE and followed prospectively, during at least 12 months, since 2017 until 2020. Rebleeding was defined as an overt bleeding event (melena or hematochezia) or a hemoglobin decrease of at least 2 g/dL. The RHEMITT score was calculated for each patient and the rebleeding rates compared. The performance of the score was tested by calculating the area under curve of the receiver operator characteristic curve. A rebleeding‐free survival was assessed, corresponding to the period between the date of SBCE and the date of the first post‐SBCE rebleeding event. Results We included 162 patients, 102 (62.9%) were female, with a mean age of 64 years old. The sensitivities and specificities of the score grades for predicting rebleeding were as following: for low‐risk patients, 0% (0–10%) and 28.8% (21.1–36.5%); for intermediate‐risk patients, 23.3% (8.2–38.4%) and 72% (64.3–79.7%); for high‐risk patients, 76.7% (61.6–91.8%) and 99.2% (97.7–100%), corresponding to an area under curve of the receiver operator characteristic of 0.988 (P < 0.001). Kaplan–Meyer plots were statistically different according to the attributed risk (log‐rank P value <0.001; Breslow–Wilcoxon P value <0.001). Conclusion The RHEMITT score performed with excellent discriminative power in predicting rebleeding risk, and we herewith propose a surveillance of MGIB patients guided by the RHEMITT score.

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Long-Term Prognosis of Patients with Obscure Gastrointestinal Bleeding: A Retrospective Cohort Study

Cited by 4 publications

References 23 publications

Clinical usefulness and acceptability of small‐bowel capsule endoscopy with panoramic imaging compared with axial imaging in Japanese patients

Clinical usefulness and acceptability of small‐bowel capsule endoscopy with panoramic imaging compared with axial imaging in Japanese patients

Small bowel angioectasia as a marker of frailty and poor prognosis

RHEMITT score: Predicting the risk of mid gastrointestinal rebleeding after small bowel capsule endoscopy: A prospective validation

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