title: What is the long-term outcome of a negative capsule endoscopy in patients with obscure gastrointestinal bleeding?
abstract: OBJECTIVE
  There are contradictory findings regarding long-term outcome in patients with obscure gastrointestinal bleeding and negative capsule endoscopy. Factors associated with rebleeding after a negative videocapsule are not entirely known.
  
  
  OBJECTIVE
  The aim of this study was to compare the rebleeding rate between negative and positive capsule endoscopy patients and to identify predictive factors for rebleeding in patients with negative findings.
  
  
  METHODS
  Consecutive patients with obscure gastrointestinal bleeding referred to a single center over a period of 5 years were identified. After exclusion of patients with a follow time < 6 months, 173 patients were included. Clinical information was retrospectively collected from medical records. Rebleeding was defined as evidence of melena/hematochezia, a drop in hemoglobin of ≥ 2 g/dL, or the need for transfusion 30 days after the index episode.
  
  
  RESULTS
  The mean age was 61.7 years and 60% were female. The median follow up time was 27 months. Most patients were referred for occult gastrointestinal bleeding (67.1%) while 32.9% were referred for overt bleeding. More than 50% of the patients had negative capsule endoscopy. The rebleeding rate in negative capsule endoscopy is 16%, with a mean follow-up time of 25.8 months and is significantly lower than positive capsule endoscopy (16% vs. 30.2%, p = 0.02). Rebleeding after negative capsule endoscopy is higher in patients who need more transfusions of packet red blood cells before capsule endoscopy (3.0 vs. 0.9, p = 0.024) and have overt bleeding (46% vs. 13.9%, p = 0.03). In 53% of these patients, rebleeding occurs > 12 months after a negative capsule endoscopy.
  
  
  CONCLUSIONS
  Patients with obscure gastrointestinal bleeding and a negative capsule endoscopy had a significantly lower rebleeding rate and can be safely followed. However, a higher transfusion of red blood cells previous to capsule endoscopy and an overt bleeding are associated with a higher rebleeding. So, it is reasonable to consider that these patients may benefit of at least one year of follow-up.
authors.affiliation: Gastrenterologia e Hepatologia, Centro Hospitalar Vila Nova Gaia, Portugal.
authors.forename: Iolanda
authors.initials: I
authors.lastname: Ribeiro
authors.affiliation: Gastroenterology and Hepatology department, Centro Hospitalar de Gaia/Espinho, Portugal.
authors.forename: Rolando
authors.initials: R
authors.lastname: Pinho
authors.affiliation: Gastroenterology and Hepatology department, Centro Hospitalar de Gaia/Espinho, Portugal.
authors.forename: Adélia
authors.initials: A
authors.lastname: Rodrigues
authors.affiliation: Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Silva
authors.affiliation: Gastrenterologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Ponte
authors.affiliation: Gastrenterologia, Centro Hospitalar Vila Nova Gaia, Portugal.
authors.forename: Jaime
authors.initials: J
authors.lastname: Rodrigues
authors.affiliation: Gastroenterology and Hepatology department, Centro Hospitalar de Gaia/Espinho, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Carvalho
mesh_terms: D000328:Adult; D000359:Aftercare; D000368:Aged; D053704:Capsule Endoscopy; D017707:Erythrocyte Transfusion; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors