Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2018; 10(4): 74-82
Published online Apr 16, 2018. doi: 10.4253/wjge.v10.i4.74
Impact of the timing of capsule endoscopy in overt obscure gastrointestinal bleeding on yield and rebleeding rate - is sooner than 14 d advisable?
Catarina Gomes, Rolando Pinho, Adélia Rodrigues, Ana Ponte, Joana Silva, Jaime Pereira Rodrigues, Mafalda Sousa, João Carlos Silva, João Carvalho
Catarina Gomes, Rolando Pinho, Adélia Rodrigues, Ana Ponte, Joana Silva, Jaime Pereira Rodrigues, Mafalda Sousa, João Carlos Silva, João Carvalho, Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto 4434502, Portugal
Author contributions: Gomes C and Pinho R designed the study, performed the research, analyzed the data and wrote the paper; Rodrigues A, Ponte A, Silva J, Rodrigues JP, Sousa M, Silva JC and Carvalho J performed the research and analyzed the data.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Catarina Gomes, MD, Doctor, Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, Vila Nova de Gaia, Porto 4434502, Portugal. catarina.rib.gomes@gmail.com
Telephone: +351-22-7865100 Fax: +351-22-7868369
Received: December 3, 2017
Peer-review started: December 4, 2017
First decision: December 22, 2017
Revised: January 18, 2018
Accepted: March 14, 2018
Article in press: March 15, 2018
Published online: April 16, 2018
Abstract
AIM

To evaluate the impact of the timing of capsule endoscopy (CE) in overt-obscure gastrointestinal bleeding (OGIB).

METHODS

Retrospective, single-center study, including patients submitted to CE in the setting of overt-OGIB between January 2005 and August 2017. Patients were divided into 3 groups according to the timing of CE (≤ 48 h; 48 h-14 d; ≥ 14 d). The diagnostic and therapeutic yield (DY and TY), the rebleeding rate and the time to rebleed were calculated and compared between groups. The outcomes of patients in whom CE was performed before (≤ 48 h) and after 48 h (> 48 h), and before (< 14 d) and after 14 d (≥ 14 d), were also compared.

RESULTS

One hundred and fifteen patients underwent CE for overt-OGIB. The DY was 80%, TY-46.1% and rebleeding rate - 32.2%. At 1 year 17.8% of the patients had rebled. 33.9% of the patients performed CE in the first 48 h, 30.4% between 48h-14d and 35.7% after 14 d. The DY was similar between the 3 groups (P = 0.37). In the ≤ 48 h group, the TY was the highest (66.7% vs 40% vs 31.7%, P = 0.005) and the rebleeding rate was the lowest (15.4% vs 34.3% vs 46.3% P = 0.007). The time to rebleed was longer in the ≤ 48 h group when compared to the > 48 h groups (P = 0.03).

CONCLUSION

Performing CE within 48 h from overt-OGIB is associated to a higher TY and a lower rebleeding rate and longer time to rebleed.

Keywords: Overt-obscure gastrointestinal bleeding, Capsule endoscopy, Timing, Diagnosis, Therapeutic, Rebleeding

Core tip: An early diagnosis with capsule endoscopy (CE) in overt-obscure gastrointestinal bleeding (OGIB) patients can lead to an appropriate specific intervention, better long term-outcomes and reduce unnecessary medical costs. In this paper we evaluated the impact of the timing of CE in these patients. ESGE recommends performing CE as soon as possible after the bleeding episode, optimally within 14 d. We found that in spite of a similar diagnostic yield, performing CE within 48 h is associated with greater therapeutic yield, less rebleeding episodes, and a longer rebleeding-free time. This suggests that a more timely approach in the evaluation of overt-OGIB than the 14 d recommendation is advisable.