Clinical outcomes of negative small-bowel capsule endoscopy for small-bowel bleeding: a systematic review and meta-analysis

Yung, Diana E; Koulaouzidis, Anastasios; Avni, Tomer; Kopylov, Uri; Giannakou, Andry; Rondonotti, Emanuele; Pennazio, Marco; Eliakim, Rami; Tóth, Ervin; Plevris, John

doi:10.1016/j.gie.2016.08.027

Cited by 65 publications

(72 citation statements)

References 42 publications

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“…However, in many cases, the underlying cause of OGIB cannot be determined. An in-depth analysis of rebleeding among patients with OGIB was reported in a prior study [6]. At our institute, we found that to optimize the diagnostic yield, CE should be performed within a short time after bleeding, and that negative CE on examination in patients with OGIB is closely related to the use and cessation of low-dose aspirin prior to CE [8].…”

Section: Discussionmentioning

confidence: 66%

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Long-Term Prognosis of Patients with Obscure Gastrointestinal Bleeding: A Retrospective Cohort Study

et al. 2019

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Aims: We evaluated the long-term prognosis of patients with obscure gastrointestinal bleeding (OGIB) who underwent capsule endoscopy (CE). Methods: In our hospital, 429 patients underwent CE between November 2007 and March 2012. Among them, 259 patients underwent CE as the first examination for OGIB and were then followed at 77 clinics and hospitals. The clinical characteristics were investigated, including age, gender, overt/occult bleeding, the use of antithrombotic drugs and NSAIDs, complications (liver cirrhosis and hemodialysis), and CE. We asked the medical institutions for their survival data as of August 2017 (> 5 years after CE). Results: The prognoses of 240 patients (92.6%) were analyzed. The average follow-up period was 55.7 (1–115) months. During the follow-up period, 57 patients (23.8%) died and the survival rates were 90.5% at 1 year, 81.7% at 3 years, and 74.7% at 5 years. Age 65 years or older and liver cirrhosis were predictive factors for a poor prognosis. Rebleeding occurred in 42 patients (17.9%) and small bowel cancer and gastrointestinal stromal tumor were found at 12 and 21 months after CE, respectively. Conclusions: Patients with OGIB showed a poor prognosis, especially those who were elderly or who had liver cirrhosis.

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Section: Discussionmentioning

confidence: 66%

“…However, some patients with OGIB have comorbid conditions in their medical histories, and the prognosis may be poor in such cases. Although the prognosis for rebleeding has been investigated fully [6], the survival prognosis for patients with OGIB has not been thoroughly assessed.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Prognosis of Patients with Obscure Gastrointestinal Bleeding: A Retrospective Cohort Study

et al. 2019

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“…Firstly, investigation of potential differences in long-term re-bleeding rate after negative VCE was not the primary endpoint of early Western studies (17,21,39,40); thus, questions about their power are raised. Beyond the small size of the examined population, the study design may also be considered as a caveat: prospective studies reported significantly lower re-bleeding rate after negative VCE compared to retrospective trials (9). An issue that should be also highlighted is the follow-up period.…”

Section: Re-bleeding Rate After Index Vce Small Bowel Examinationmentioning

confidence: 99%

“…At present, VCE holds the pivotal role in the optimal evaluation strategy for patients with OGIB (6). It is superior to push enteroscopy, barium contrast radiology, computed tomography and magnetic resonance imaging for diagnosing clinically significant small bowel lesions (7)(8)(9). At the same time, it achieves complete small bowel examination in about 80-85% of the cases and demonstrates equivalent diagnostic yield to device-assisted enteroscopy (10)(11)(12), retaining its noninvasive nature, patient tolerability and excellent safety profile (13).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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Obscure gastrointestinal bleeding (OGIB) accounts for approximately 5% of all gastrointestinal (GI) hemorrhages. It usually arises from a small bowel lesion beyond the reach of conventional endoscopy including esophagogastroduodenoscopy and colonoscopy. Video capsule endoscopy (VCE) revolutionized the evaluation of OGIB patients since it allows reliable and noninvasive visualization of the small bowel mucosal surface. Since 2001, VCE has evolved into an efficient technology integrated in clinical practice. It is the cornerstone in the algorithm of OGIB investigation given its high diagnostic yield, which compares favorably to that of double-balloon enteroscopy (DBE). In terms of outcomes, a positive index VCE examination usually correlates to a high re-bleeding rate, while a negative one provides adequate evidence of low re-bleeding risk, suggesting a wait and watch approach in this subset of patients. Additionally, a variety of factors has been acknowledged as significant predictors of re-bleeding episodes. While research data regarding immediate endoscopic findings have matured, data concerning the clinical utility of VCE in patients with OGIB on the long-term remain sparse. This manuscript reviews the current literature, aiming to highlight the role of VCE in the long-term management of OGIB.

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“…The pooled DY for SBCE and DBE is 60%–61% and 55%–57%, respectively 5. Evidence for a low rebleeding rate following a negative SBCE adds further to the reliability of SBCE 6. The DY of SBCE in Crohn’s disease (CD) is similar to the DY of magnetic resonance enterography (MRE) and CT enterography (CTE).…”

Section: Introductionmentioning

confidence: 99%

Optimising the use of small bowel endoscopy: a practical guide

Zammit

Sanders

McAlindon

et al. 2019

Frontline Gastroenterol

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The wireless nature of capsule endoscopy offers patients the least invasive option for small bowel investigation. It is now the first-line test for suspected small bowel bleeding. Furthermore meta-analyses suggest that capsule endoscopy outperforms small bowel imaging for small bowel tumours and is equivalent to CT enterography and magnetic resonance enterography for small bowel Crohn’s disease. A positive capsule endoscopy lends a higher diagnostic yield with device-assisted enteroscopy. Device-assisted enteroscopy allows for the application of therapeutics to bleeding points, obtain histology of lesions seen, tattoo lesions for surgical resection or undertake polypectomy. It is however mainly reserved for therapeutics due to its invasive nature. Device-assisted enteroscopy has largely replaced intraoperative enteroscopy. The use of both modalities is discussed in detail for each indication. Current available guidelines are compared to provide a concise review.

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Clinical outcomes of negative small-bowel capsule endoscopy for small-bowel bleeding: a systematic review and meta-analysis

Abstract: Our analysis shows that negative CE provides adequate evidence of a subsequently low risk of rebleeding. Such patients can therefore be safely managed with watchful waiting. However, patients who rebleed after 2 years may need to be investigated for a new source of blood loss.

Cited by 65 publications

References 42 publications

Long-Term Prognosis of Patients with Obscure Gastrointestinal Bleeding: A Retrospective Cohort Study

Long-Term Prognosis of Patients with Obscure Gastrointestinal Bleeding: A Retrospective Cohort Study

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

Optimising the use of small bowel endoscopy: a practical guide

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