Cúrdia Gonçalves Tiago, Dias de Castro Francisca, Moreira Maria João, Rosa Bruno, Cotter José
aGastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães bLife and Health Sciences Research Institute, University of Minho, Braga/Guimarães cICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal.
Eur J Gastroenterol Hepatol. 2014 Aug;26(8):927-32. doi: 10.1097/MEG.0000000000000135.
BACKGROUND/AIM: Small bowel capsule endoscopy (SBCE) is currently a fundamental tool in the etiological study of obscure gastrointestinal bleeding (OGIB). However, the impact of a negative exam and the risk of rebleeding are not entirely known. The aim of this study was to evaluate the outcomes of patients with OGIB and a negative SBCE examination in terms of follow-up duration, additional diagnostic studies, and achievement of a diagnosis as well as to assess the incidence of rebleeding and possible associated factors.
We retrospectively analyzed 256 patients who consecutively underwent an SBCE examination for the study of OGIB between April 2006 and December 2011, and then selected the 79 whose results excluded potentially bleeding lesions. Eleven patients were lost to follow-up and the remaining 68 were eligible for a nested case-control analysis. Pre-SBCE and post-SBCE information was collected, including follow-up interval and incidence of rebleeding, defined as admission to the hospital for symptomatic anemia, need for blood transfusion, decrease in hemoglobin value of greater than 2 g/dl, or evidence of melena or hematochezia. Univariate analysis included age, sex, OGIB presentation (occult or visible), hemoglobin levels at presentation, and comorbidities.
In the 68 patients analyzed, the mean age was 52±18 years and 61.8% were women. The OGIB was occult in 54 patients (79.4%) and overt in 14 patients (20.6%). Patients were followed up for an average of 32 months. Thirty-nine patients (57.4%) underwent further diagnostic investigations during the period of follow-up and a cause for the gastrointestinal bleeding was found in five of them. Rebleeding was documented in 16 (23.5%) patients, occurring on average 15±13.8 months after the SBCE. Male sex was associated significantly with higher incidence of rebleeding (P=0.004).
Approximately one quarter of patients with OGIB and negative SBCE examination will experience rebleeding, with higher incidence among men; thus, a negative SBCE in this setting is not reassuring. As the vast majority of rebleeding episodes seem to occur within the following 2 years after SBCE, the maintenance of regular medical surveillance during the above-mentioned period of time after a negative SBCE seems advisable.
背景/目的：小肠胶囊内镜检查（SBCE）目前是不明原因胃肠道出血（OGIB）病因学研究的一项基本工具。然而，阴性检查的影响以及再出血风险尚不完全清楚。本研究的目的是评估OGIB且SBCE检查结果为阴性的患者在随访时间、额外诊断性检查、诊断达成情况方面的结局，并评估再出血发生率及可能的相关因素。
我们回顾性分析了2006年4月至2011年12月期间连续接受SBCE检查以研究OGIB的256例患者，然后选取了79例结果排除潜在出血性病变的患者。11例患者失访，其余68例符合巢式病例对照分析条件。收集了SBCE检查前和检查后的信息，包括随访间隔和再出血发生率，再出血定义为因症状性贫血住院、需要输血、血红蛋白值下降超过2g/dl，或有黑便或便血证据。单因素分析包括年龄、性别、OGIB表现（隐匿性或显性）、就诊时血红蛋白水平和合并症。
在分析的68例患者中，平均年龄为52±18岁，61.8%为女性。54例患者（79.4%）的OGIB为隐匿性，14例患者（20.6%）为显性。患者平均随访32个月。39例患者（57.4%）在随访期间接受了进一步的诊断性检查，其中5例发现了胃肠道出血的原因。16例（23.5%）患者有再出血记录，平均发生在SBCE后15±13.8个月。男性与再出血发生率显著相关（P=0.004）。
OGIB且SBCE检查结果为阴性的患者中约四分之一会发生再出血，男性发生率更高；因此，在这种情况下SBCE结果为阴性并不能让人放心。由于绝大多数再出血事件似乎发生在SBCE后的2年内，在SBCE结果为阴性后的上述时间段内进行定期医学监测似乎是可取的。
