Sa1479 Clinical Utility of Balloon Enteroscopy Subsequent to Negative Capsule Endoscopy for Obscure Gastrointestinal Bleeding

Abstract

Ewha Womans University School of Medicine, Seoul, Republic of Korea; Inje University Seoul Paik Hospital, Seoul, Republic of Korea; Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea; Yonsei University College of Medicine, Seoul, Republic of Korea Background/Aims: Capsule endoscopy (CE) has been widely used as a first-line diagnostic modality for obscure gastrointestinal bleeding (OGIB). However, the long-term clinical impact of CE in patients with OGIB remains undetermined. Furthermore, most studies have limitations of a relatively small size and/or a single-center experience. We evaluated the long-term clinical impact of CE in patients with OGIB using the national CE registry in Korea. Methods: A total 305 consecutive patients who underwent CE for OGIB from 13 hospitals in South Korea between January 2006 and March 2009 were analyzed. We reviewed the prospectively collected CE registry data and collected follow-up data by chart review and by phone call to the patient for lacking data. Primary end point was rebleeding. Secondary end points included readmission for bleeding and transfusion requirement. Results: Of them, 187 (61.3%) were male and the mean age was 56.9 17.1 (SD) years. Thirty five patients (11.5%) were occult-OGIB and 270 (88.5%) were overt-OGIB. Clinically significant positive findings were detected in 131 patients (43.0%): active ulcer in 81 patients (26.6%), angiodysplasia in 29 (9.5%), active bleeding with no identifiable cause in 11 (3.6%), small bowel tumor in 6 (2.0%), diverticulum in 2 (0.7%), and small bowel varix in 2 (0.7%). After CE, specific treatment was performed in 71 patients (23.3%). The overall rebleeding rate was 19.0% during a mean follow-up of 38.7 26.4 (SD) months. There was no significant difference in the cumulative rebleeding rate between patients with positive and negative significant CE findings (19.1% vs. 19.0%, P 1.00). Specific treatments after CE did not significantly decrease rebleeding (hazard ratio 1.09; 95% confidence interval, 0.79-1.50; P 0.61). Readmission rate and transfusion requirement for rebleeding did not differ according to the significant positive CE findings and specific treatment (P 0.05 for all comparisons). When the patients were subdivided by categorized CE findings, rebleeding rate differed between subgroups: 12.3% in negative CE findings, 33.3% in angiodysplasia, 7.4% in localized findings including small bowel tumor, single ulcer, and diverticulum, and 38.5% in multiple erosions (P 0.002). However, rebleeding rate did not differ between patients with and without specific treatment in the each subgroup. Conclusion: Rebleeding after CE in patients with OGIB was determined by its cause and not affected by application of specific treatment. The patients with angiodysplasia and multiple erosions need to be closely followed-up due to high rebleeding risk.