title: Predictive factor of re-bleeding after negative capsule endoscopy for obscure gastrointestinal bleeding: over 1-year follow-up study.
abstract: OBJECTIVE
  Capsule endoscopy (CE) is now widely accepted as a first-line diagnostic modality for obscure gastrointestinal bleeding (OGIB), with a high diagnostic yield compared to other modalities. However, even after negative CE examination, re-bleeding is often known to occur. The aim of the present study was to identify predictive factors of re-bleeding after negative CE, and to clarify the clinical utility of double-balloon enteroscopy (DBE) after negative CE for OGIB.
  
  
  METHODS
  Two hundred and sixty patients who underwent CE for OGIB between October 2007 and September 2012 were included, and followed up for at least 1 year after CE examination. Demographic and clinical parameters associated with re-bleeding after negative CE were investigated.
  
  
  RESULTS
  A total of 154 patients (59.2%) had negative findings. Thirteen of those patients (8.4%) had one or more re-bleeding episodes during the follow-up period. In comparing patients with and without re-bleeding, Cox hazard regression analysis revealed that advanced age was a predictive factor for re-bleeding after negative CE (hazard ratio 1.05 [1.01-1.10], P = 0.03). Subsequent DBE for reasons other than re-bleeding was carried out in 51 patients (33.1%). Mucosal lesions (ulcer or multiple erosions) were subsequently detected in seven patients (13.7%), and endoscopic therapies were carried out in two patients (3.9%).
  
  
  CONCLUSIONS
  In patients of advanced age, more extensive follow up is needed, even if the CE result is negative. In addition, DBE subsequent to negative CE may be useful to detect lesions that were overlooked on CE.
authors.affiliation: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Matsumura
authors.forename: Makoto
authors.initials: M
authors.lastname: Arai
authors.forename: Keiko
authors.initials: K
authors.lastname: Saito
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Okimoto
authors.forename: Masaya
authors.initials: M
authors.lastname: Saito
authors.forename: Shoko
authors.initials: S
authors.lastname: Minemura
authors.forename: Arata
authors.initials: A
authors.lastname: Oyamada
authors.forename: Daisuke
authors.initials: D
authors.lastname: Maruoka
authors.forename: Tomoo
authors.initials: T
authors.lastname: Nakagawa
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Watabe
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Katsuno
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
mesh_terms: D000368:Aged; D053704:Capsule Endoscopy / Q000009:adverse effects*; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D058582:Double-Balloon Enteroscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors
keywords: capsule endoscopy; double-balloon enteroscopy; obscure gastrointestinal bleeding; predictive facor; re-bleeding