HIGH REBLEEDING RATE IN PATIENTS EVALUATED FOR OBSCURE GASTROINTESTINAL BLEEDING AFTER A FALSE-NEGATIVE DEEP ENTEROSCOPY

Aims:

Data on the long-term outcomes after a false-negative enteroscopy in obscure gastrointestinal bleeding (OGIB), following capsule endoscopy (CE) with positive findings is scarce.

Aim:

To evaluate rebleeding rate, risk factors and characteristics of rebleeding in OGIB patients with false-negative enteroscopy after positive CE.

Methods:

Retrospective single-center analysis of 24 patients with false negative-enteroscopy, after a positive CE. Patients: 62.5% female, median age 64.5 years-old (IQR 50.2 – 74.0), 37.5% presenting with overt-OGIB.

Results:

Previous CE findings: subepitelial lesions (n = 9), blood (n = 6), inflammatory lesions (n = 5), angioectasias (n = 2), polyps (n = 2). The lesions were isolated in 20 patients and multiple in 4, and located in duodenum (n = 1), jejunum (n = 10), ileum (n = 11), and multiple segments (n = 2). Enteroscopy was performed via the oral route in 15 patients, anal route in 8, and oral + anal in 1 patient. 13 patients had no findings at the enteroscopy, and 11 patients had non-significant findings.

Rebleeding occurred in 45.8% (n = 11). The rebleeding rate at 1 month, 1, 2, 3 and 4 years was 20.8%, 25.2%, 35.9%, 50.6% and 62.9%, respectively. 90.9% (n = 10) of rebleeding patients underwent further radiological/endoscopic evaluation, of which only 4 had a conclusive diagnosis and treatment (2 vascular lesions and 2 small-bowel tumors). Rebleeding patients had higher median transfusion requirements (p = 0.001) and lower hemoglobin (p = 0.02) (4 [IQR 2 – 8], 7.7 IQR [6.2 – 8.8]) than non-rebleeding patients (0 [IQR 0 – 1], 10.3 [IQR 8.2 – 11.0]), respectively and presented more often with overt-OGIB (p = 0.001, 88.9% vs. 20%). No association between the presence of comorbidities or the use anticoagulants/antiplatelet drugs and rebleeding was found.

Conclusions:

Patients with a false-negative enteroscopy have a high rebleeding rate. Despite further evaluation after a rebleeding episode, a conclusive diagnosis is obtained in only 36.4% of the patients. Patients with overt-OGIB, lower hemoglobin and higher transfusion requirements have higher rebleeding rate. These patients need close follow-up.