Negative capsule endoscopy in patients with obscure gastrointestinal bleeding reliable: Recurrence of bleeding on long-term follow-up

Abstract

Patients with obscure gastrointestinal bleeding and negative CE had a significantly lower rebleeding rate, and further invasive investigations can be deferred.

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

“…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).…”

“…At best, it can determine which patients are most likely to benefit from subsequent therapeutic work-up. Patients with positive VCE necessitate endoscopic interventions for effective treatment and DBE has been shown to provide significant aid in patients with small bowel lesions or those who are at high risk for re-bleeding despite a non-diagnostic VCE (25,35). In a meta-analysis of seven studies, the diagnostic yield for DBE after negative VCE for OGIB was 27.5% (95% CI, 16.7-37.8%) (12), while VCE followed by DBE has been established as an effective strategy for investigating OGIB and particularly to confirm a negative VCE examination (53).…”

“…Riccioni et al (25) conducted a retrospective single center study of 696 OGIB cases with follow-up period averaging 24 months. The re-bleeding rate was higher in patients with positive VCE than in cases with negative study (45.2% vs. 16.4%, P=0.001), thus concluding that a negative VCE correlates to low long-term re-bleeding rate and further invasive investigations could be deferred.…”

Obscure gastrointestinal bleeding and “obscure” capsule. May we switch on any lights?

“…In this indication CE has demonstrated a high diagnostic capacity (55-92%) (7)(8)(9)(10). However, we know bleeding cannot be equally attributed to the various lesions found by CE (11), and lesions unlikely to bleed or even no lesions are often our sole finding, which happens in up to 30% of studies (12). These are patients with bleeding evidence (overt or as anemia) where tests, including CE, provide no information regarding its origin.…”

“…Some papers on retrospective series show a high diagnostic yield (32%) for repeat CE (15). However, given that the risk for re-bleeding following a negative CE seems to be low, around 15% (12,16), in the group with a lower risk for re-bleeding conservative, waitand-see management is recommended without further diagnostic testing.…”