title: Negative capsule endoscopy in patients with obscure gastrointestinal bleeding reliable: recurrence of bleeding on long-term follow-up.
abstract: OBJECTIVE
  To assess the rate of recurrent bleeding of the small bowel in patients with obscure bleeding already undergone capsule endoscopy (CE) with negative results.
  
  
  METHODS
  We reviewed the medical records related to 696 consecutive CE performed from December 2002 to January 2011, focusing our attention on patients with recurrence of obscure bleeding and negative CE. Evaluating the patient follow-up, we analyzed the recurrence rate of obscure bleeding in patient with a negative CE. Actuarial rates of rebleeding during follow-up were calculated, and factors associated with rebleeding were assessed through an univariate and multivariate analysis. A P value of less than 0.05 was regarded as statistically significant. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of negative CE were calculated.
  
  
  RESULTS
  Two hundred and seven out of 696 (29.7%) CE studies resulted negative in patient with obscure/overt gastrointestinal bleeding. Overall, 489 CE (70.2%) were positive studies. The median follow-up was 24 mo (range 12-36 mo). During follow-up, recurrence of obscure bleeding was observed only in 34 out of 207 negative CE patients (16.4%); 26 out of 34 with obscure overt bleeding and 8 out of 34 with obscure occult bleeding. The younger age (< 65 years) and the onset of bleeding such as melena are independent risk factors of rebleeding after a negative CE (OR = 2.6703, 95%CI: 1.1651-6.1202, P = 0.0203; OR 4.7718, 95%CI: 1.9739-11.5350, P = 0.0005). The rebleeding rate (CE+ vs CE-) was 16.4% vs 45.1% (χ(2) test, P = 0.00001). The sensitivity, specificity, and PPV and NPV were 93.8%, 100%, 100%, 80.1%, respectively.
  
  
  CONCLUSIONS
  Patients with obscure gastrointestinal bleeding and negative CE had a significantly lower rebleeding rate, and further invasive investigations can be deferred.
authors.affiliation: Digestive Endoscopy Unit, Catholic University of Rome, 00168 Rome, Italy.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Riccioni
authors.forename: Riccardo
authors.initials: R
authors.lastname: Urgesi
authors.forename: Rossella
authors.initials: R
authors.lastname: Cianci
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rizzo
authors.forename: Luca
authors.initials: L
authors.lastname: D'Angelo
authors.forename: Riccardo
authors.initials: R
authors.lastname: Marmo
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
mesh_terms: D000368:Aged; D053704:Capsule Endoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012008:Recurrence; D015203:Reproducibility of Results; D012307:Risk Factors; D013997:Time Factors
keywords: Anemia; Capsule endoscopy; Enteroscopy; Obscure gastrointestinal bleeding; Rebleeding
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