title: Long-term outcome in patients with obscure gastrointestinal bleeding after capsule endoscopy.
abstract: OBJECTIVE
  This study aimed to identify the risk factors associated with rebleeding and long-term outcomes after capsule endoscopy (CE) for obscure gastrointestinal bleeding (OGIB) in a follow-up study.
  
  
  METHODS
  Data of consecutive patients who underwent CE due to OGIB from June 2002 to January 2012 were retrospectively reviewed. The Cox proportional hazard model was used to evaluate the risk factors associated with rebleeding, while Kaplan-Meier survival curves and the log-rank test were used to analyze cumulative rebleeding rates.
  
  
  RESULTS
  The overall rebleeding rate after CE in patients with OGIB was 28.6% (97/339) during a median follow-up of 48 months (range 12-112 months). Multivariate analysis showed that age ≥60 years (hazard ratio [HR] 2.473, 95% confidence interval [CI] 1.576-3.881, P = 0.000), positive CE findings (HR 3.393, 95% CI 1.931-5.963, P = 0.000), hemoglobin ≤70 g/L before CE (HR 2.010, 95% CI 1.261-3.206, P = 0.003), nonspecific treatments (HR 2.500, 95% CI 1.625-3.848, P = 0.000) and the use of anticoagulants, antiplatelet or non-steroidal anti-inflammatory drugs after CE (HR 2.851, 95% CI 1.433-5.674, P = 0.003) were independent risk factors associated with rebleeding. Univariate analysis showed that chronic hepatitis was independently associated with rebleeding in CE-negative patients (P = 0.021).
  
  
  CONCLUSIONS
  CE has a significant impact on the long-term outcome of patients with OGIB. Further investigation and close follow-up in patients with OGIB and those with negative CE findings are necessary.
authors.affiliation: Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Tan
authors.forename: Zhi Zheng
authors.initials: ZZ
authors.lastname: Ge
authors.forename: Yun Jie
authors.initials: YJ
authors.lastname: Gao
authors.forename: Xiao Bo
authors.initials: XB
authors.lastname: Li
authors.forename: Jun
authors.initials: J
authors.lastname: Dai
authors.forename: Seng Wang
authors.initials: SW
authors.lastname: Fu
authors.forename: Yao
authors.initials: Y
authors.lastname: Zhang
authors.forename: Han Bing
authors.initials: HB
authors.lastname: Xue
authors.forename: Yun Jia
authors.initials: YJ
authors.lastname: Zhao
mesh_terms: D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014741:Video Recording / Q000379:methods
keywords: capsule endoscopy; gastrointestinal hemorrhage; obscure gastrointestinal bleeding; rebleeding; risk factors