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Abstract

We read with interest the correspondence from van de Bruaene et al1Van de Bruaene C. Hindryckx P. De Looze D. Capsule endoscopy in obscure GI bleeding: better to be negative, but let us not be too positive.Gastrointest Endosc. 2017; 86: 574-575Abstract Full Text Full Text PDF Scopus (2) Google Scholar in response to our meta-analysis2Yung D.E. Koulaouzidis A. Avni T. et al.Clinical outcomes of negative small-bowel capsule endoscopy for small-bowel bleeding: a systematic review and meta-analysis.Gastrointest Endosc. 2017; 85: 305-317Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar on rebleeding rates after negative results of small-bowel capsule endoscopy (SBCE) for small-bowel bleeding (SBB; previously OGIB). We would like to thank them for the information they provided.3Van De Bruaene C. Hindryckx P. Snauwaert C. et al.Long-term follow-up in patients with OGIB and normal capsule endoscopy.Gastrointest Endosc. 2015; 81 ([abstract]): AB138Abstract Full Text Full Text PDF Google Scholar, 4Van de Bruaene C. Hindryckx P. Snauwaert C. et al.The predictive value of negative capsule endoscopy for the indication of obscure gastrointestinal bleeding: no reassurance in the long term.Acta Gastroenterol Belg. 2015; 79: 405-413Google Scholar The authors mention that in the long term (>2 years), their patients had a high rate of rebleeding of 34%; however, it is interesting to note that most of those patients had a bleeding source outside the small bowel. This further supports the conclusion of our meta-analysis that patients with a negative SBCE result have a low rate of small-bowel rebleeding. Patients presenting with rebleeding after a prolonged period of follow-up should therefore be investigated as “new” cases, including consideration of repeated conventional endoscopy. Moreover, emerging biomarkers for SBB, such as angiopoietin-2, offer promise as potential noninvasive screening tools.5Holleran G. Hall B. O’Regan M. et al.Expression of angiogenic factors in patients with sporadic small bowel angiodysplasia.J Clin Gastroenterol. 2015; 49: 831-836Crossref PubMed Scopus (24) Google Scholar Such markers, once refined, could be used to select patients for SBCE, therefore decreasing further the number of unnecessary investigations with negative results. All authors disclosed no financial relationships relevant to this publication. Capsule endoscopy in obscure GI bleeding: better to be negative, but let us not be too positiveGastrointestinal EndoscopyVol. 86Issue 3PreviewIt was with great interest that we read the systematic review and meta-analysis of Yung et al1 on the clinical outcomes of negative small-bowel (SB) capsule endoscopy (CE) in obscure GI bleeding (OGIB). This is the first review analyzing the pooled rate of rebleeding after negative CE results (ie, .19; [.14-.25]; P < .0001) and positive CE results (ie, .29; [.23-.36]; P < .001) for the indication of OGIB, with significantly higher rebleeding rates after positive examination results (P < .001). In their conclusion, Yung et al1 provide the reader with very useful guidance in the management of OGIB in CE-negative patients. Full-Text PDF