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

Abstract

Background and AimAlthough small‐bowel capsule endoscopy (CE) is widely used for obscure gastrointestinal bleeding (OGIB), long‐term outcomes for OGIB patients after negative CE remain unclear. Herein, we defined negative CE as P0 (no bleeding potential) or P1 (less likely to bleed), based on the P classification using CE. We aimed to clarify long‐term outcomes of patients with OGIB after negative CE.MethodsThis single‐center observational study enrolled 461 consecutive patients with OGIB who underwent CE from March 2014 to October 2021 and were followed up for >1 year. We examined rebleeding rates and predictive factors.ResultsTwo hundred and twenty‐four (49%) patients had P0, and 237 (51%) had P1 findings. Rebleeding occurred in 9% and 16% of patients in the P0 and P1 groups, respectively. Two patients in the P0 group and 15 in the P1 group showed rebleeding from the small bowel. The rate of small‐bowel rebleeding was significantly lower in the P0 group than that in the P1 group (1% vs 6%, P = 0.002), as was the cumulative rebleeding rate (P = 0.004). In the multivariate analysis, history of endoscopic hemostasis (hazard ratio [HR] = 15.958, 95% confidence interval [CI]:4.950–51.447, P < 0.001) and P1 CE findings (HR = 9.989, 95% CI: 2.077–48.030, P = 0.004) were independently predicted small‐bowel rebleeding.ConclusionsOGIB with P0 CE findings rarely showed rebleeding from the small bowel. Rebleeding may occur in patients with OGIB. Patients with history of endoscopic hemostasis for small‐bowel lesions or P1 CE findings should be followed up intensively.