Predictive factor of re‐bleeding after negative capsule endoscopy for obscure gastrointestinal bleeding: <scp>O</scp>ver 1‐year follow‐up study

<jats:sec><jats:title>Background and Aim</jats:title><jats:p>Capsule endoscopy (<jats:styled-content style="fixed-case">CE</jats:styled-content>) is now widely accepted as a first‐line diagnostic modality for obscure gastrointestinal bleeding (<jats:styled-content style="fixed-case">OGIB</jats:styled-content>), with a high diagnostic yield compared to other modalities. However, even after negative <jats:styled-content style="fixed-case">CE</jats:styled-content> examination, re‐bleeding is often known to occur. The aim of the present study was to identify predictive factors of re‐bleeding after negative <jats:styled-content style="fixed-case">CE</jats:styled-content>, and to clarify the clinical utility of double‐balloon enteroscopy (<jats:styled-content style="fixed-case">DBE</jats:styled-content>) after negative <jats:styled-content style="fixed-case">CE</jats:styled-content> for <jats:styled-content style="fixed-case">OGIB</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Two hundred and sixty patients who underwent <jats:styled-content style="fixed-case">CE</jats:styled-content> for <jats:styled-content style="fixed-case">OGIB</jats:styled-content> between <jats:styled-content style="fixed-case">O</jats:styled-content>ctober 2007 and <jats:styled-content style="fixed-case">S</jats:styled-content>eptember 2012 were included, and followed up for at least 1 year after <jats:styled-content style="fixed-case">CE</jats:styled-content> examination. Demographic and clinical parameters associated with re‐bleeding after negative <jats:styled-content style="fixed-case">CE</jats:styled-content> were investigated.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 154 patients (59.2%) had negative findings. Thirteen of those patients (8.4%) had one or more re‐bleeding episodes during the follow‐up period. In comparing patients with and without re‐bleeding, <jats:styled-content style="fixed-case">C</jats:styled-content>ox hazard regression analysis revealed that advanced age was a predictive factor for re‐bleeding after negative <jats:styled-content style="fixed-case">CE</jats:styled-content> (hazard ratio 1.05 [1.01–1.10], <jats:italic>P</jats:italic> = 0.03). Subsequent <jats:styled-content style="fixed-case">DBE</jats:styled-content> for reasons other than re‐bleeding was carried out in 51 patients (33.1%). Mucosal lesions (ulcer or multiple erosions) were subsequently detected in seven patients (13.7%), and endoscopic therapies were carried out in two patients (3.9%).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In patients of advanced age, more extensive follow up is needed, even if the <jats:styled-content style="fixed-case">CE</jats:styled-content> result is negative. In addition, <jats:styled-content style="fixed-case">DBE</jats:styled-content> subsequent to negative <jats:styled-content style="fixed-case">CE</jats:styled-content> may be useful to detect lesions that were overlooked on <jats:styled-content style="fixed-case">CE</jats:styled-content>.</jats:p></jats:sec>