Negative capsule endoscopy without subsequent enteroscopy does not predict lower long-term rebleeding rates in patients with obscure GI bleeding

Park, Sung Chul; Cheon, Jae Hee; Kim, Hee Man; Park, Hyeun Sung; Moon, Chang Mo; Lee, Jin Ha; Hong, Sung Pil; Kim, Tae Il; Kim, Won Ho

doi:10.1016/j.gie.2009.12.009

Cited by 63 publications

(84 citation statements)

References 38 publications

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“…The finding that small bowel ulcer, instead of angiodysplasia was the most common cause of OGIB in this study needs attention. Angiodysplasia is well-known to be the most common cause of OGIB among Western patients but no convincing data to show that this holds true among Asians [18][19][20][21] . Some [18,20] reported angiodysplasia as a main cause of OGIB, while others [19,21] report ulcers to be the main etiology.…”

Section: Characteristics Of Patients According To the Etiologymentioning

confidence: 99%

“…Angiodysplasia is well-known to be the most common cause of OGIB among Western patients but no convincing data to show that this holds true among Asians [18][19][20][21] . Some [18,20] reported angiodysplasia as a main cause of OGIB, while others [19,21] report ulcers to be the main etiology. However, when considered large studies that include more than 100 patients, one study from India [21] and two double-balloon enteroscopy studies from Japan [22,23] , all showed that small bowel ulcers were the most common cause of OGIB (41%-53%), more common than angiodysplasia (23%-24%).…”

Section: Characteristics Of Patients According To the Etiologymentioning

confidence: 99%

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Yield, etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding

Pongprasobchai¹

2013

WJGE

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AIM:To investigate the yield, etiologies and impact of capsule endoscopy (CE) in Thai patients with obscure gastrointestinal bleeding (OGIB). METHODS:The present study is a retrospective cohort study. All patients with OGIB who underwent CE in Siriraj Hospital, Bangkok, Thailand during 2005-2009 were included in the study. All the patients' medical records and results of the CE videos were reviewed. CE findings were classified as significant, suspicious/equivocal and negative. Sites of the lesions were located to duodenum, jejunum, jejunoileum, ileum and diffuse lesions by the localization device of the CE. Impact of CE on the patients' management was defined by any investigation or treatment given to the patients that was more than an iron supplement or blood transfusion. Patients' outcomes (rebleeding, persistent bleeding, anemia or requirement of blood transfusion) were collected from chart reviews and direct phone interviews with the patients. RESULTS:Overall, there were 103 patients with OGIB included in the study. Mean age of the patients was 64 ± 16 years (range 9-88 years) and 57 patients (55%) were male. Types of OGIB were overt in 80 (78%) and occult in 23 patients (22%). The median time interval of CE after onset of OGIB was 10 d (range 1-180 d). The median time of follow-up was 19 mo (range 1-54 mo). Capsules reached caecum in 77 patients (74%) and capsule retention was found in 1 patient (1%). The diagnostic yield of CE revealed significant lesions in 37 patients (36%), suspicious/equivocal lesions in 15 patients (15%) and 51 patients (49%) had negative CE result. Among the significant lesions, the bleeding etiologies were small bowel ulcers in 44%, angiodysplasia in 27%, small bowel tumor in 13%, miscellaneous in 8% and active bleeding without identifiable causes in 8%. Patients with small bowel ulcers were significantly associated with the use of non-steroidal anti-inflammatory drugs (48%, P = 0.034), while patients with small bowel tumors were more commonly female (86%, P = 0.043) compared to the other etiologies. The rate of rebleeding, persistent bleeding or anemia in patients with positive, equivocal and negative CE results were 5%, 0% and 18%, respectively (P = 0.078). All the 9 patients with rebleeding after negative CE were subsequently found to be from hematologic disorders (4), colonic diverticulosis (2), colonic Dieulafoy's (1), hemorrhoid (1) and hemosuccus pancreaticus (1). Results of CE had a positive impact on the patients' management in 35% of the patients whose results were positive, but none on the patients whose results were equivocal or negative CE (P < 0.001). CONCLUSION:In Thai OGIB patients, CE had low yield and small bowel ulcer was most common. Positive CE impacted managements and outcomes. Negative CE caused low rebleeding.

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Section: Characteristics Of Patients According To the Etiologymentioning

confidence: 99%

Section: Characteristics Of Patients According To the Etiologymentioning

confidence: 99%

Yield, etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding

Pongprasobchai¹

2013

WJGE

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“…Authors concluded that VCE negative patients should undergo regular follow-up, whilst being mindful that the bleeding may not originate from the small bowel. Park et al (34), in a Korean single center retrospective analysis of 57 consecutive patients followed for 31.7 months, found a comparable re-bleeding rate between patients with positive and negative VCE exams (34.8% vs. 35.7%, P=0.989), suggesting that this might be due to a 19.6% miss rate of VCE for small bowel lesions, in the setting of equal small-bowel transit time (SBTT) during OGIB between re-bleeders and non-re-bleeders (31). In another Korean study, Kim et al (35) reported a re-bleeding rate of 26.7% in patients with negative VCE without subsequent treatment and 21.2% in positive VCE without specific treatment, respectively (P=0.496).…”

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

confidence: 99%

“…Studies reporting very low re-bleeding rates had relative short follow-up (17,19,21,36,40,41). Contrariwise, Korean studies enrolled relatively more subjects with longer follow-up, exceeding 2 years (32,34,35,37). This possibly allowed Park et al (34) to display a re-bleeding rate of 35.7% during the 32 months follow-up, while Koh et al (32) showed that more than half of the patients suffered bleeding recurrence more than 1 year after the initial episode with the maximum time to re-bleeding being 24 months post-procedurally.…”

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

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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“…In a series of 173 consecutive patients tested for OGIB they discuss the 2-year follow-up of cases where CE found no condition as a source of bleeding. Since re-bleeding odds are variable in these patients, different factors associated with a higher re-bleeding risk have been posited, but the evidence thus far reported remains controversial (14). These authors highlight that high transfusion requirements before CE and overt OGIB are factors clearly associated with re-bleeding in patients with OGIB and a negative CE study.…”

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confidence: 99%

Obscure gastrointestinal bleeding and obscure capsule. May we switch on any lights?

Pons-Beltrán¹

2015

Rev Esp Enferm Dig

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Negative capsule endoscopy without subsequent enteroscopy does not predict lower long-term rebleeding rates in patients with obscure GI bleeding

Cited by 63 publications

References 38 publications

Yield, etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding

Yield, etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding

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

Obscure gastrointestinal bleeding and obscure capsule. May we switch on any lights?

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Negative capsule endoscopy without subsequent enteroscopy does not predict lower long-term rebleeding rates in patients with obscure GI bleeding

Cited by 63 publications

References 38 publications

Yield, etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding

Yield, etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding

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

Obscure gastrointestinal bleeding and obscure capsule. May we switch on any lights?

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Obscure gastrointestinal bleeding and obscure capsule. May we switch on any lights?