[Risk factors for re-bleeding events in obscure gastrointestinal bleeding patients with negative findings in capsule endoscopy]

Abstract

Objective: To investigate the frequency of and risk factors for re-bleeding in obscure gastrointestinal bleeding (OGIB) patients who had negative findings in capsule endoscopy (CE).

Methods: Patients with OGIB referred for CE to the First Affiliated Hospital of Zhengzhou University between January 2011 and December 2012 were identified.Follow-up data were obtained via medical records review, telephone interviews or follow-up clinic visits in order to establish the rate of re-bleeding and identify the risk factors associated with re-bleeding among patients with negative CE findings.

Results: A total of 198 patients were included in this study, of whom 196 patients completed the follow-up, with a mean (±SD) follow-up of (16.1±5.3) months. In the 196 patients, 94 had negative CE findings and did not receive any further specific treatment for OGIB. Re-bleeding episodes were observed in 32 of the 94 patients (34.0%), and the cumulative re-bleeding rates at 6, 12, 18, and 24 months in follow-up were 3.2%, 6.4%, 20.2%, 34.0%, respectively. There was no statistically significant difference in re-bleeding rate between patients with positive CE findings and patients with negative CE findings (23.7% vs 34.0%, P=0.246). Diabetes mellitus (HR=3.250, 95%CI: 1.296-8.154, P=0.012), minimum hemoglobin levels ≤80 g/L before CE (HR=0.397, 95%CI: 0.172-0.917, P=0.031), and continued use of aspirin after CE (HR=4.915, 95%CI: 1.887-12.800, P=0.001) were independent risk factors for re-bleeding among OGIB patients with negative CE findings.

Conclusions: Considering the high risk of re-bleeding, close follow-ups are needed for OGIB patients with negative CE findings.Repeated CE or other investigations (enteroscopy and CT enterography) within 12-24 months are recommended for the OGIB patients with negative findings in initial CE investigation who have risk factors for re-bleeding.