title: The predictive value of negative capsule endoscopy for the indication of Obscure Gastrointestinal Bleeding: no reassurance in the long term.
abstract: BACKGROUND
  Capsule Endoscopy (CE) has become the first-line tool to identify an underlying etiology for Obscure Gastrointestinal Bleeding (OGIB) in the small bowel (SB). This study aims to investigate the long-term outcome of patients with a negative CE.
  
  
  METHODS
  Retrospective review of standardized application forms of all patients who underwent CE for OGIB at the Ghent University Hospital between 2002 and 2013. Follow-up data on patients with a negative CE result (n=263) were collected by contacting the referring physician.
  
  
  RESULTS
  Follow-up was available for 211 patients (Male, n=107 ; Female, n=104 ; Overt bleeding, n=76 ; Occult bleeding, n=135). Median follow-up time was 51.7 months (range 1.4-139.6 months). Ninety-six patients underwent further diagnostics, showing a cause for OGIB in 57 (59.4%). Final outcome for the complete cohort of negative CEs was : 139 (65.9%) true negative (i.e. non-SB cause of bleeding/ resolved OGIB), 19 (9%) false negative (i.e. SB cause of OGIB) and 53 (25.1%) ongoing bleeding without cause. Missed SB lesions were : angiodysplasia (n=11), Meckel's diverticulum (n=3), SB malignancy (n=3), jejunal erosions (n=1) and NSAID-induced SB ulcerations (n=1). Bleeding resolved in 138/209 patients (66%) of which 79 underwent non-specific therapy.
  
  
  CONCLUSIONS
  Negative CEs in patients with OGIB do not reassure the treating physician, but warrant close monitoring. In suspicious cases, alternative diagnostic modalities are recommended, showing a high diagnostic yield. (Acta gastroenterol. belg., 2016, 79, 405-413).
authors.forename: C
authors.initials: C
authors.lastname: Van de Bruaene
authors.forename: P
authors.initials: P
authors.lastname: Hindryckx
authors.forename: C
authors.initials: C
authors.lastname: Snauwaert
authors.forename: D
authors.initials: D
authors.lastname: Dooremont
authors.forename: B
authors.initials: B
authors.lastname: Vanduyfhuys
authors.forename: L
authors.initials: L
authors.lastname: Vandenabeele
authors.forename: M
authors.initials: M
authors.lastname: De Vos
authors.forename: D
authors.initials: D
authors.lastname: De Looze
mesh_terms: D000368:Aged; D001530:Belgium / Q000453:epidemiology; D053704:Capsule Endoscopy / Q000379:methods / Q000706:statistics & numerical data; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D007421:Intestine, Small / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies