Abstract
BackgroundFor patients with obscure gastrointestinal bleeding (OGIB), finding the bleeding site is challenging. Balloon-assisted enteroscopy (BAE) has become the preferred diagnostic modality for OGIB. The long-term outcome of patients with negative BAE remains undefined. The present study aimed to evaluate the long-term outcomes of patients with negative BAE results for OGIB and to clarify the effect of further investigations at the time of rebleeding with a systematic review and meta-analysis of the available cohort studies.MethodsStudies were searched through the PubMed, EMBASE, and Cochrane library databases. The following indexes were analyzed: rebleeding rate after negative BAE, rebleeding rate after different follow-up periods, the proportion of patients who underwent further evaluation after rebleeding, the percentage of patients with identified rebleeding sources, and the percentage of patients with rebleeding sources in the small intestine. Heterogeneity was assessed using the I2 test.ResultsTwelve studies that involved a total of 407 patients were included in the analysis. The pooled rebleeding rate after negative BAE for OGIB was 29.1% (95% CI: 17.2–42.6%). Heterogeneity was significant among the studies (I2 = 88%; p < 0.0001). The Chi-squared test did not show a difference in rebleeding rates between the short and long follow-up period groups (p = 0.142). The pooled proportion of patients who underwent further evaluation after rebleeding was 86.1%. Among the patients who underwent further evaluation, rebleeding sources were identified in 73.6% of patients, and 68.8% of the identified rebleeding lesions were in the small intestine.ConclusionA negative result of BAE in patients with OGIB indicates a subsequently low risk of rebleeding. Further evaluation should be considered after rebleeding.
Highlights
The small intestine has always been difficult to evaluate thoroughly because of its long length and variable looped configuration
The pooled rebleeding rate after negative balloon-assisted enteroscopy (BAE) for obscure gastrointestinal bleeding (OGIB) was 29.1%
The Chi-squared test did not show a difference in rebleeding rates between the short and long follow-up period groups (p = 0.142)
Summary
The small intestine has always been difficult to evaluate thoroughly because of its long length and variable looped configuration. Before balloon-assisted enteroscopy (BAE) was introduced in clinical practice in 2001, endoscopic examination of the small intestine was unsatisfactory, and treatment of small intestinal disease often required surgical laparotomy with intraoperative enteroscopy. BAE has become the preferred method for examination of the small intestine in OGIB. BAE can examine much more of the small intestine compared with push enteroscopy and can achieve a much higher diagnostic yield [9, 10]. A prospective study of patients with OGIB who underwent BAE showed reduced bleeding and blood transfusion [21]. The long-term outcome of patients with negative BAE remains undefined. The present study aimed to evaluate the long-term outcomes of patients with negative BAE results for OGIB and to clarify the effect of further investigations at the time of rebleeding with a systematic review and meta-analysis of the available cohort studies
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
