Management of occult obscure gastrointestinal bleeding patients based on long-term outcomes

Abstract

Background:There is no consensus regarding the management of occult obscure gastrointestinal bleeding (OGIB) patients without a confirmed bleeding source. This study aimed to consider the management of occult OGIB patients based on their long-term outcomes.Methods:We retrospectively enrolled 357 consecutive occult OGIB patients (203 men; mean age: 59.7 years) who underwent capsule endoscopy (CE) at Hiroshima University Hospital, Japan and were followed up for more than 12 months (mean follow-up period; 50.2 months). Patients were divided into three groups as follows: Group A consisted of 98 of 157 patients who had positive findings and indication for treatment, Group B consisted of 59 of 157 patients who had positive findings but no indication for treatment, and Group C consisted of 200 patients who had negative small-bowel findings. We examined the rate of positive CE findings, detection rate and details of bleeding sources, overt bleeding rate, the rate of anemia exacerbation, 5-year anemia exacerbation rate, and overall survival rate.Results:The positive CE findings rate was 44% (157/357) and detection rate of bleeding source was 27% (98/357). The details of Group A were as follows: angioectasia (n = 61), nonspecific ulceration (n = 10), nonsteroidal anti-inflammatory drug-induced ulcer (n = 8), and others (n = 19). The details of Group B were as follows: erythema (n = 31), angioectasia (n = 25), and others (n = 3). There were no patients with overt bleeding in Group B. Although six patients had anemia exacerbation in Group B, they had angioectasia without a bleeding source.Conclusion:The long-term outcomes of occult OGIB patients were good. Occult OGIB patients without bleeding source lesions may not require follow-up CE.

RHEMITT Score: Predicting the Risk of Rebleeding for Patients with Mid-Gastrointestinal Bleeding Submitted to Small Bowel Capsule Endoscopy

“…Endoscopic capsule lesions ("E") are stratified regarding their risk of gastrointestinal bleeding according to Saurin classification: P2 lesions have a high bleeding potential, P1 lesions a mild bleeding risk, and P0 lesions a very low risk. As expected, taking into account findings described by Kunihara et al [25], we found the highest rebleeding rate for patients with P2 lesions, followed by those with P1 lesions [17]. The different SBCE findings are stated in Table 1: nodules, lymphangiectasias, red spots, erosions, angioectasiae, ulcers, and tumors.…”

AGA Technical Review on Gastrointestinal Evaluation of Iron Deficiency Anemia

“…The certainty of evidence was very low due to high risk of bias (selection bias due to inclusion of symptomatic patients and patients referred to specialty centers for CE). [108][109][110][111][112][113][114][115][116][117][118][119][120][121][122][123] Additionally, in a recent study that followed 93 patients with IDA for more than 5 years, no small bowel malignancies were identified. 124 However, the comparative efficacy of CE in IDA remains undefined.…”

Exacerbation of Portal Hypertensive Enteropathy after Endoscopic Injection Sclerotherapy for Esophageal Varices

“…An investigation of the causes of bleeding in patients with occult obscure gastrointestinal bleeding at our institution indicated that 83% of these patients had treatment-adapted lesions. Furthermore, 49% of patients had a history of LC; however, the bleeding sources were vascular lesions such as angioectasia and varices [37].…”