Rebleeding rate after interventional therapy directed by capsule endoscopy in patients with obscure gastrointestinal bleeding

Abstract

Background: The precise role of capsule endoscopy in the diagnostic algorithm of obscure gastrointestinal bleeding has yet to be determined. Despite the higher diagnostic yield of capsule endoscopy, the actual impact on clinical outcome remains poorly defined. The aim of this study was to evaluate the follow-up results of patients with obscure gastrointestinal bleeding to determine which management strategies after capsule endoscopy reduced rebleeding.

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

“…Albert et al (22) found that VCE results determined the therapy in 66% of the cases and led to an alteration in management in 32.3% of the cases. In accordance, Endo et al (33) found that the re-bleeding rate of patients who underwent therapeutic intervention after positive VCE small bowel exam was significantly lower (9.5% vs. 40.0%, P=0.046) than that of those who did not undergo treatment. Consistently, Park et al (34) demonstrated that when specific treatment after VCE (DBE not included) was applied, a significant decrease in re-bleeding was noted (HR: 0.111; 95% CI, 0.013-0.980; P=0.043).…”

“…Endo and associates (33) found significantly higher rate of re-bleeding in patients with negative VCE, compared to those with significant findings (50% vs. 12%). Authors concluded that VCE negative patients should undergo regular follow-up, whilst being mindful that the bleeding may not originate from the small bowel.…”

Evaluation and outcomes of patients with obscure gastrointestinal bleeding

“…With regards to rebleeding rates, Endo et al [18] found that among patients with significant CE findings, the rebleeding rate at a mean of 11.6 mo follow up of the patients who underwent therapeutic intervention was significantly lower than that of those without intervention (9.5% vs 40.0%, P = 0.046). This is supported by other studies [83,84] .…”

“…CE enables direct visualisation of the small bowel mucosa and has a high sensitivity for detecting flat lesions, such as angiodysplasias, ulcers and arteriovenous malformations which are not easily detectable on radiological modalities [15] . The reported diagnostic yield in literature ranges from 58.4% to 86.8% [9,14,[16][17][18][19][20][21] . The wide range is attributable to different definitions of a positive finding on CE.…”

“…Patients with insignificant findings (erosions, small ulcers, red spots, small polyps) or a negative CE, had a significantly higher rate of re-bleeding than those with significant findings on CE. These patients should have careful follow up, whilst being mindful that the bleeding may not be originating from the small bowel [18] . Viazis et al [85] found that 65% of patients with a negative initial CE continued to have OGIB after a mean follow up period of 24 mo.…”