title: Long-term outcomes of obscure gastrointestinal bleeding after CT enterography: does negative CT enterography predict lower long-term rebleeding rate?
abstract: OBJECTIVE
  Computed tomography enterography (CTE) is a promising modality for small bowel imaging. However, the role of CTE in the evaluation of obscure gastrointestinal bleeding (OGIB) has not been established. We investigated the efficacy of CTE in diagnosing OGIB and the long-term outcomes based on CTE findings, with special reference to negative CTE.
  
  
  METHODS
  A total of 63 consecutive patients who had undergone CTE for OGIB were enrolled, and their pre- and post-CTE clinical data were collected. "Specific treatments" were defined as treatments directly aimed at resolving presumed bleeding causes, including hemostasis and operation, while "non-specific treatments" were defined as symptomatic treatments for anemia.
  
  
  RESULTS
  Among 60 patients for whom long-term follow-up data were available, positive lesions were found in 16 patients (26.7%). The overall rebleeding rate was 21.7% during a mean follow up of 17.6 ± 4.7 months. There was no significant difference in the cumulative rebleeding rates between patients with positive and negative CTE results (P = 0.241). All patients who received specific treatments after CTE did not rebleed (0/8). In positive CTE patients, specific treatments significantly reduced the rebleeding rate (P = 0.023).
  
  
  CONCLUSIONS
  CTE has a high rate of detecting overt OGIB. However, negative CTE results do not predict lower long-term rebleeding, and such patients with OGIB should be closely observed. In patients with positive CTE, more vigorous management significantly reduces the incidence of rebleeding.
authors.affiliation: Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jae Kook
authors.initials: JK
authors.lastname: Shin
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Cheon
authors.forename: Joon Seok
authors.initials: JS
authors.lastname: Lim
authors.forename: Jae Jun
authors.initials: JJ
authors.lastname: Park
authors.forename: Chang Mo
authors.initials: CM
authors.lastname: Moon
authors.forename: Soung Min
authors.initials: SM
authors.lastname: Jeon
authors.forename: Jin Ha
authors.initials: JH
authors.lastname: Lee
authors.forename: Sung Pil
authors.initials: SP
authors.lastname: Hong
authors.forename: Tae Il
authors.initials: TI
authors.lastname: Kim
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000209:etiology; D003287:Contrast Media; D004573:Electrolytes; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008551:Melena / Q000209:etiology; D008875:Middle Aged; D011092:Polyethylene Glycols; D011237:Predictive Value of Tests; D012008:Recurrence; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D004573:Electrolytes; C033608:Golytely; D011092:Polyethylene Glycols