Rebleeding rate after interventional therapy directed by capsule endoscopy in patients with obscure gastrointestinal bleeding

Hiroki Endo¹ , Nobuyuki Matsuhashi² , Masahiko Inamori¹ , Keiko Akimoto² , Tomohiko Ohya² , Tatsuro Yanagawa² , Masako Asayama² , Kantaro Hisatomi² , Takuma Teratani² , Koji Fujita¹ , Masato Yoneda¹ and Atsushi Nakajima¹

¹Division of Gastroenterology, Yokohama City University School of Medicine, Yokohama, Japan

²Department of Gastroenterology, Kanto Medical Center NTT EC, Tokyo, Japan

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BMC Gastroenterology 2008, 8:12doi:10.1186/1471-230X-8-12


Published:	23 April 2008

Abstract

Background

The precise role of capsule endoscopy in the diagnostic algorithm of obscure gastrointestinal bleeding has yet to be determined. Despite the higher diagnostic yield of capsule endoscopy, the actual impact on clinical outcome remains poorly defined. The aim of this study was to evaluate the follow-up results of patients with obscure gastrointestinal bleeding to determine which management strategies after capsule endoscopy reduced rebleeding.

Methods

All patients in whom the cause of obscure gastrointestinal bleeding was investigated between May 2004 and March 2007 were studied retrospectively. We evaluated the clinical outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy using the rebleeding rate as the primary outcome.

Results

Seventy-seven patients with obscure gastrointestinal bleeding underwent capsule endoscopy. Capsule endoscopy identified clinically significant findings that were thought to be the sources of obscure gastrointestinal bleeding in 58.4% of the patients. The overall rebleeding rate was 36.4%. The rebleeding rate was significantly higher among patients with insignificant findings than among those with significant findings (p = 0.036). Among the patients in whom capsule endoscopy produced significant findings, the rebleeding rate of the patients who underwent therapeutic interventions was significantly lower than that in those who did not undergo intervention (9.5% vs 40.0%, p = 0.046).

Conclusion

Follow-up and further aggressive interventions are necessary for patients with obscure gastrointestinal bleeding and significant capsule endoscopy findings to reduce the chance of rebleeding.