Clinical Outcomes between P1 and P0 Lesions for Obscure Gastrointestinal Bleeding with Negative Computed Tomography and Capsule Endoscopy

Abstract

Background: A simple classification for the relevance of lesions (P0, P1, and P2; no bleeding potential, less likely to bleed, and more likely to bleed, respectively) based on capsule endoscopy (CE) findings has been used. This study aimed at investigating rebleeding rates and predictive factors of P0 and P1 lesions after obtaining negative findings in both, CE and computed tomography (CT), for patients with obscure gastrointestinal bleeding (OGIB). Methods: Among 193 patients resulted in negative CE findings defined as P0 or P1 lesions, 84 patients with negative results on CT images were enrolled in this study. The rebleeding rates and predictive factors were assessed in the P0 and P1 groups. Results: Overall rebleeding rate in patients with negative CT and CE was 17.9%; 18.4% in the P0 group; 17.4% in the P1 group within a median follow-up duration of 18.5 months. In the P0 and P1 groups, the cumulative rebleeding rates were 9.2%, 25.4%, and 25.4%, and 6.9%, 11.8%, and 18.6% at 12, 24, and 60 months, respectively (p = 0.97). There were no independent rebleeding associated factors in the P0 group, whereas Charlson comorbidity index (CCI) (hazard ratio (HR) = 2.019, 95% confidence interval (CI): 1.158–3.519, p = 0.013), and initial low hemoglobin (Hb) level (<8 g/dL) (HR = 15.085, 95% CI: 1.182–192.514, p = 0.037) were independent predictive factors responsible for rebleeding in the P1 group. Conclusions: Despite having negative findings on CT and CE, patients with OGIB have a significant potential rebleeding risk. Although there was no significant difference in rebleeding rates between the P0 and P1 groups on CE, the P1 group, with CCI or low initial Hb level, should be cautiously observed after the first bleeding episode.

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

“…However, in the long-term, recurrence of bleeding is not uncommon 53 54 55 , and further investigations could be required. In these cases, repeating the diagnostic workup by SBCE appears to have more diagnostic value than DAE; a small study from Japan showed that the rate of positive findings in the repeat SBCE group was significantly higher than in the DBE group 56 .…”

Long‐term outcomes of patients with obscure gastrointestinal bleeding after negative capsule endoscopy

“…17 Thus, they concluded that the rebleeding rates of the P0 and P1 groups did not differ. 17 However, we hypothesized that the risk of rebleeding would differ between patients with no abnormalities and those with minor small-bowel abnormalities.…”

“…[9][10][11] However, definitions of negative CE findings vary among reports; most define "negative" as P0 or P1, although some define "negative" as P0 only. [12][13][14][15][16][17] Moreover, rebleeding rates of patients with negative CE findings vary widely among reports, ranging from 4.8 % to 50%. [11][12][13][14][15][16][17] Few reports compare long-term outcomes of P0 and P1 OGIB.…”

“…[12][13][14][15][16][17] Moreover, rebleeding rates of patients with negative CE findings vary widely among reports, ranging from 4.8 % to 50%. [11][12][13][14][15][16][17] Few reports compare long-term outcomes of P0 and P1 OGIB. To our knowledge, only one paper compared P0 and P1.…”

“…Numerous studies have reported rebleeding rates in patients with OGIB and with negative CE findings 9–11 . However, definitions of negative CE findings vary among reports; most define “negative” as P0 or P1, although some define “negative” as P0 only 12–17 . Moreover, rebleeding rates of patients with negative CE findings vary widely among reports, ranging from 4.8 % to 50% 11–17 .…”