Factors associated with the clinical impact of capsule endoscopy in patients with overt obscure gastrointestinal bleeding.
OBJECTIVE
Capsule endoscopy (CE) does not necessarily identify positive findings in patients with overt obscure gastrointestinal bleeding (OGIB). We aimed to identify factors predictive of positive CE findings and those of re-bleeding after negative CE in overt OGIB.


METHODS
We retrospectively analyzed 68 patients who underwent CE for overt OGIB. CE findings, therapeutic interventions, and clinical course after CE were reviewed. Clinical variables associated with positive CE findings and those associated with re-bleeding after negative CE findings were investigated.


RESULTS
Positive CE finding was found in 36 (53%) patients. Marked decrease in hemoglobin value [OR; 18.8, 95% CI; 3.4-152.0] and earlier CE examination within a week after the last episode of bleeding [OR; 8.0, 95% CI; 2.2-35.9] were factors associated with positive CE findings. Nine (28%) of 32 patients with negative CE findings re-bled. Marked decrease in hemoglobin value was more frequent in patients with re-bleeding than those without (P = 0.07).


CONCLUSIONS
Patients with massive and overt OGIB are the best candidates for CE. Earlier CE, virtually within a week, contributes to the better diagnostic yield of the procedure. Careful follow-up seems necessary for patients with massive bleeding even in cases of negative CE findings.
Esaki
Motohiro
M
Department of Medicine and Clinical Science, Graduate Schools of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan. mesaki@intmed2.med.kyushu-u.ac.jp
Matsumoto
Takayuki
T
Yada
Shinichiro
S
Yanaru-Fujisawa
Ritsuko
R
Kudo
Tetsuji
T
Yanai
Shunichi
S
Nakamura
Shotaro
S
Iida
Mitsuo
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053704:Capsule Endoscopy; D002648:Child; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D012680:Sensitivity and Specificity; D055815:Young Adult