Risk factors of rebleeding in patients with obscure gastrointestinal bleeding

Abstract

Objective To investigate the long-term（ 〉 1 year） rebleeding rate after capsule endoscopy （CE）-guided intervention in patients with obscure gastrointestinal bleeding （OGIB） and to identify the risk factors of rebleeding. Methods A total of 307 consecutive patients who underwent CE for OGIB in our hospital from June 2002 to October 2010 were enrolled. Follow-up data were obtained by reviewing medical records, CE database and contacting the patients or their relatives by telephone. We evaluated the rebleeding rates and analyzed risk factors predictive of rebleeding by means of COX ratio hazard model. Results The medium follow-up was 52 months （rangel3-112 months）. Significant lesions were found in 202 patients （65.8%）. The overall rebleeding rate after interventional therapy induced by CE findings was 28.0% （86/307）. CE positive patients had higher rebleeding rate than CE negative patients （37.6% vs 9. 5%, log-rank test, P = 0. 000）, while specific therapy could prevent rebleeding, compared with nonspecific therapy （32. 9% vs 23.0%, P =0. 042）. 95.3% （82/86） rebleeding occurred within 24 months after CE. Multivariate analysis performed by using COX proportional hazards model showed that age over 50 years, CE positive findings, lowest hemoglobin （Hb） level 3 months before CE ≤7 g/dl, receiving nonspecific therapy after CE, hypertension, administration of anticoagulants, antiplatelet medicine or NSAIDs after CE were six risk factors associated with rebleeding. Conclusion Clinicians should be aware of these risk factors for OGIB rebleeding, which can reduce the occurrence of rebleeding and improve OGIB patients＇ prognosis. Those high risk OGIB patients should be followed up for at least 24 months after CE. Key words: Capsule endoscopes ; Gastrointestinal hemorrhage; Risk factors; Factor analysis