Patients with obscure gastrointestinal bleeding (OGIB) often have recurrence of bleeding in the long run necessitating close monitoring of these patients, according to a single-center study from Japan.¹

In this study, Otani et al recruited 389 patients with OGIB, who underwent capsule endoscopy as the initial small intestinal examination subsequent to negative upper and lower endoscopy from March 2004 to December 2015. The study subjects were followed up for five years after the capsule endoscopy to assess the risk of long-term rebleeding with the help of medical records or letters. The researchers also sought to find out the predictive factors for rebleeding when no source of rebleeding could be found in the GI tract.

Analysis of data showed that the overall 5-year cumulative rebleeding rate in OGIB was 41.7% in the 5 years following the capsule endoscopy. Patients who had positive findings on capsule endoscopy had a cumulative rebleeding rate of 48%. A therapeutic intervention in these patients led to a cumulative rebleeding rate of nearly 32%.

Overt or clinically visible OGIB was associated with a 2-folds increase in the risk of rebleeding with a hazard ratio of 2.01. The use of anticoagulants also nearly doubled the risk of rebleeding with HR of 1.9. Positive balloon-assisted enteroscopy findings after capsule endoscopy (HR ~3) and iron supplements without therapeutic intervention (HR 2.2) were the other risk factors for rebleeding. The risk of rebleeding was found to reduce with a higher minimum hemoglobin level (HR 0.902) and therapeutic intervention in the form of either endoscopy, interventional radiology or surgery (HR 0.28).

Among the components of the Charlson Comorbidity Index evaluating risk of mortality in patients with comorbid conditions, the presence of liver cirrhosis was associated with a 4-folds higher risk of rebleeding in patients with OGIB with HR of 4.3. The risk of recurrence of bleeding was also increased in patients with negative CE findings (HR ~9).

This observational study has shown that rebleeding is a frequent occurrence in patients with OGIB and the rebleeding rate as observed in the present study. It has also identified predictors of rebleeding in these patients, which include overt bleeding, anticoagulation, positive balloon-assisted enteroscopy findings after capsule endoscopy, iron supplementation without therapeutic intervention/s and cirrhosis. Patients with negative capsule endoscopy or those with risk factors for rebleeding require close and adequate follow-up to prevent a repeat episode of bleeding or manage it in a timely manner, should bleeding recur.

Reference

1. Koji Otani, et al. Long-term rebleeding rate and predictive factors of rebleeding after capsule endoscopy in patients with obscure gastrointestinal bleeding. Gastrointest Endosc. 2022 Jul 15;S0016-5107(22)01829-6. doi: 10.1016/j.gie.2022.07.012.