AIM:Capsule endoscopy is the first-line diagnostic method for patients with obscure gastrointestinal bleeding, however a substantial number has non-diagnostic findings. Our aim is to determine the role of capsule endoscopy, balloon-assisted enteroscopy and clinical parameters in the management of patients with obscure gastrointestinal bleeding. MATERIALS AND METHODS: 578 patients were included in this retrospective study. Capsule endoscopy and balloon-assisted enteroscopy results were classified as diagnostic (positive) or nondiagnostic (negative). Clinical variables were analyzed to find predictors associated with rebleeding within 2 years. RESULTS: Capsule endoscopy was classified as diagnostic in 160 (28%) patients, including 8 small bowel tumors. The diagnostic yield of balloon-assisted enteroscopy guided by a positive capsule examination was significantly enhanced towards 74% (52/70). A Hb level of ≤ 5.0 mmol/L was an independent factor associated with an increased risk for rebleeding after a negative capsule examination (hazard ratio= 4.375 [2.859-6.696] (p<0.001).The success rate of a diagnostic capsule endoscopy and risk for rebleeding were both significant lower in premenopausal women with occult blood loss compared to postmenopausal women (9% vs 25%, p=0.017) (5% vs 22%, p=0.009). CONCLUSION: Balloon-assisted enteroscopy should be used as a complementary procedure when guided by a diagnostic capsule endoscopy. If capsule endoscopy is non-diagnostic, additional examination is recommended in patients who present with a low Hb at onset of obscure gastrointestinal bleeding to prevent rebleeding. Occult bleeding in premenopausal woman is a poor indication for further gastrointestinal examination after conventional endoscopy.