Re-bleeding events in patients with obscure gastrointestinalbleeding after negative capsule endoscopy

a negative capsule endoscopy in patients with obscuregastrointestinal bleeding （OGIB） and the risk factorsassociated with the procedure.METHODS： Patients referred to Hospital Egas Moniz（Lisboa, Portugal） between January 2006 and October2012 with OGIB and a negative capsule endoscopy wereretrospectively analyzed. The following study variableswere included： demographic data, comorbidities,bleeding-related drug use, hemoglobin level, indicationfor capsule endoscopy, post procedure details, work-upand follow-up. Re-bleeding rates and associated factorswere assessed using a Cox proportional hazard analysis.The Kaplan-Meier method was used to estimate thecumulative incidence of re-bleeding at 1, 3 and 5 years,and the differences between factors were evaluated.RESULTS： The study population consisted of 640patients referred for OGIB investigation. Wirelesscapsule endoscopy was deemed negative in 113patients （17.7%）. A total of 64.6% of the populationwas female, and the median age was 69 years. Themedian follow-up was forty-eight months （interquartilerange 24-60）. Re-bleeding occurred in 27.4% of thecases. The median time to re-bleeding was fifteenmonths （interquartile range 2-33）. In 22.6% （n = 7）of the population, small-bowel angiodysplasia wasidentified as the culprit lesion. A univariate analysisshowed that age 〉 65 years old, chronic kidney disease,aortic stenosis, anticoagulant use and overt OGIB wererisk factors for re-bleeding; however, on a multivariateanalysis, there were no risk factors for re-bleeding. Thecumulative risk of re-bleeding at 1, 3 and 5 years offollow-up was 12.9%, 25.6% and 31.5%, respectively. Magalh‘s-Costa P et al . A long-term follow-up study for re-bleeding events Patients who presented with overt OGIB tended to rebleed sooner （median time for re-bleeding： 8.5 mo vs 22 mo）. CONCLUSION： Patients with OGIB despite a negative capsule endoscopy have a significant re-bleeding risk; therefore, these patients require an extended follow-up strategy.