Background and Aims

The incidence of rebleeding in obscure GI bleeding (OGIB) remains unclear. This study used capsule endoscopy (CE) to determine the long-term rebleeding rate and predictive factors for rebleeding in patients with OGIB.

Methods

This single-center, observational study enrolled consecutive patients with OGIB who underwent CE as the first small intestinal examination between March 2004 and December 2015 and were followed up through medical records or letters.

Results

Three hundred eighty-nine patients were included in the analysis. Survival curve analysis showed that the overall cumulative rebleeding rate in OGIB during the 5 years was 41.7%. Multivariate analysis using the Cox proportional hazards model revealed that overt OGIB (hazard ratio [HR], 2.017; 95% confidence interval [CI], 1.299-3.131; P = .002), anticoagulants (HR, 1.930; 95% CI, 1.093-3.410; P = .023), positive balloon-assisted enteroscopy findings after CE (HR, 2.927; 95% CI, 1.791-4.783; P < .001), and iron supplements without therapeutic intervention (HR, 2.202; 95% CI, 1.386-3.498; P = .001) were associated with rebleeding, whereas a higher minimum hemoglobin level (HR, .902; 95% CI, .834-.975; P = .009) and therapeutic intervention (HR, .288; 95% CI, .145-.570; P < .001) significantly reduced the risk of rebleeding. Among the Charlson Comorbidity Index components, liver cirrhosis was an independent predictor associated with rebleeding in patients with OGIB (HR, 4.362; 95% CI, 2.622-7.259; P < .001) and in patients with negative CE findings (HR, 8.961; 95% CI, 4.424-18.150; P < .001).

Conclusions

Rebleeding is common during the long-term follow-up of patients with OGIB. Careful follow-up is required for patients with liver cirrhosis or previous massive bleeding.

中文翻译：

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不明原因消化道出血患者胶囊内镜术后再出血远期再出血率及预测因素

背景和目标

不明原因胃肠道出血 (OGIB) 的再出血发生率仍不清楚。本研究使用胶囊内镜 (CE) 来确定 OGIB 患者的长期再出血率和再出血的预测因素。

方法

这项单中心观察性研究纳入了连续的 OGIB 患者，这些患者在 2004 年 3 月至 2015 年 12 月期间接受了 CE 作为第一次小肠检查，并通过病历或信函进行了随访。

结果

三百八十九名患者被纳入分析。生存曲线分析显示 OGIB 5 年内的总体累积再出血率为 41.7%。使用 Cox比例风险模型的多变量分析显示，明显的 OGIB（风险比 [HR]，2.017；95% 置信区间 [CI]，1.299-3.131；P  = .002）、抗凝剂（HR，1.930；95% CI，1.093 -3.410；P  = .023），CE 后球囊辅助小肠镜检查结果呈阳性（HR，2.927；95% CI，1.791-4.783； P  < .001），并且在没有治疗干预的情况下补铁（HR，2.202；95% CI） , 1.386-3.498; P  = .001) 与再出血相关，而最低血红蛋白水平较高 (HR, .902; 95% CI, .834-.975; P = .009) 和治疗干预（HR, .288; 95% CI, .145-.570; P  < .001）显着降低了再出血的风险。在 Charlson 合并症指数成分中，肝硬化是与 OGIB 患者（HR，4.362；95% CI，2.622-7.259；P  <.001）和 CE 阴性结果（HR，8.961 ；P <.001）患者再出血相关的独立预测因子。 95% CI，4.424-18.150；P  < .001）。

结论

在 OGIB 患者的长期随访期间，再出血很常见。对于肝硬化或既往大出血的患者，需要仔细随访。