title: Long-Term Outcomes in Patients with Overt Obscure Gastrointestinal Bleeding After Negative Double-Balloon Endoscopy.
abstract: BACKGROUND
  The long-term outcomes of patients after negative double-balloon endoscopy (DBE) for obscure gastrointestinal (GI) bleeding remain unclear.
  
  
  OBJECTIVE
  The aim of this study was to assess the long-term outcomes of patients with negative DBE and clarify the effect of repeat endoscopic work-up.
  
  
  METHODS
  A total of 42 patients with a negative DBE for overt obscure GI bleeding were enrolled, and their clinical data were retrospectively reviewed. The mean (± standard deviation) follow-up period is 5.4 (± 2.8) years. The outcome measurement was overt rebleeding witnessed by the patient after negative DBE. At the time of rebleeding, further endoscopic work-up and specific treatment were performed.
  
  
  RESULTS
  Rebleeding occurred in 16 of 42 patients (38%). At the time of rebleeding, further investigations were made in 14 of 16 patients (88%), and the bleeding source was identified in 10 of 14 patients (71%). These 10 patients received specific treatment (endoscopic in five, surgical in two, medical in two, and angiographic in one). The bleeding source was in the small intestine in seven of 10 patients (70%). Blood transfusion before DBE and multiple bleeding episodes before DBE were significant predictive factors for rebleeding (odds ratio 5.056, 95% confidence interval 1.158-22.059, p = 0.031 and odds ratio 8.167, 95% confidence interval 1.537-43.392, p = 0.014, respectively).
  
  
  CONCLUSIONS
  The rebleeding rate after a negative DBE is considerable. Careful long-term follow-up and repeat endoscopic work-up at the time of overt rebleeding are important.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. shinozaki-s@aqua.ocn.ne.jp.|Shinozaki Medical Clinic, Tochigi, Japan. shinozaki-s@aqua.ocn.ne.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shinozaki
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. tomonori@jichi.ac.jp.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yano
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. 94036hs@jichi.ac.jp.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Sakamoto
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. k-sunada@jichi.ac.jp.
authors.forename: Keijiro
authors.initials: K
authors.lastname: Sunada
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. hayashi@jichi.ac.jp.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. hiro55@jichi.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sato
authors.affiliation: Department of Surgery, Jichi Medical University, Tochigi, Japan. alefor@jichi.ac.jp.
authors.forename: Alan Kawarai
authors.initials: AK
authors.lastname: Lefor
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. ireef@jichi.ac.jp.
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamamoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058582:Double-Balloon Enteroscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000473:pathology*; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Double-balloon endoscopy; Hemorrhage; Outcomes research; Small intestine