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

Abstract

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). 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. 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. 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.