Outcome of patients with obscure gastrointestinal bleeding after negative capsule endoscopy: results of a one-year follow-up study.
BACKGROUND
Capsule endoscopy (CE) is an effective method for investigating the small bowel, especially in cases of obscure gastrointestinal bleeding (OGIB), although the long-term outcome of patients with a negative CE is generally not known.


METHODS
For 49 patients with OGIB and a negative CE, their referring physicians filled out a follow-up questionnaire to assess bleeding recurrence and any repeat investigations after negative video capsule endoscopy (VCE).


RESULTS
A minimum follow-up duration of one year (median: 15.9 months) was available for 35 patients with an overall rebleeding rate of 23% (n=8). Of these eight patients, four women presented with recurrence prior to new investigations. In the four remaining patients, repeat endoscopy work-ups after negative CE were performed and revealed previously missed lesions with bleeding potential, mainly in the stomach. Overall, 13 patients, with or without rebleeding, had repeat endoscopy work-ups after a negative CE, leading to a definitive diagnosis in nine patients, with lesions located in the stomach and colon in eight of them.


CONCLUSIONS
Patients with OGIB and a negative CE had a low rate of rebleeding. This study highlights the importance of the initial endoscopy work-up, and suggests that CE be proposed after a minimum of two gastroscopies and one complete colonoscopy.
Lorenceau-Savale
C
C
Service d'hépatogastroentérologie et nutrition, centre hospitalier universitaire de Rouen, 76031 Rouen cedex, France. camillelorenceau@hotmail.com
Ben-Soussan
E
E
Ramirez
S
S
Antonietti
M
M
Lerebours
E
E
Ducrotté
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D053704:Capsule Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires