Diana E Yung1, Anastasios Koulaouzidis1, Tomer Avni2, Uri Kopylov3, Andry Giannakou4, Emanuele Rondonotti5, Marco Pennazio6, Rami Eliakim3, Ervin Toth7, John N Plevris1. 1. Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. 2. Department of Medicine E, Rabin Medical Center, Petach Tikva and Sackler Medical School, Tel Aviv, Israel. 3. Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 4. Faculty of Economics and Management, The Open University of Cyprus, Nicosia, Cyprus. 5. Gastroenterology Unit, Valduce Hospital, Como, Italy. 6. Division of Gastroenterology U, San Giovanni AS University-Teaching Hospital, Torino, Italy. 7. Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden.
Abstract
BACKGROUND AND AIMS: Small-bowel bleeding is the primary indication for capsule endoscopy (CE). Many experts advocate a "watch-and-wait" policy in negative CE. This meta-analysis examines the odds of rebleeding after negative index CE and the impact on long-term follow-up. METHODS: A comprehensive literature search identified articles examining the rebleeding rate after negative CE. Demographic and clinical information with emphasis on outcomes was retrieved, pooled, and analyzed. Heterogeneity among studies was assessed using the I2 statistic. A random effects model was used as the pooling method because of high heterogeneity. Risk of bias was assessed using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. The primary outcome evaluated was the pooled odds ratios (ORs) for rebleeding after a negative CE for obscure GI bleeding (OGIB). RESULTS: Twenty-six studies with 3657 patients were included. The pooled rate of rebleeding after negative CE was .19 (95% CI, .14-.25; P < .0001). The pooled OR of rebleeding was .59 (95% CI, .37-.95; P < .001). The effect was more pronounced in studies with a short follow-up (OR, .47; 95% CI, .24-.94; P < .001). There was no statistically significant difference in rebleeding after CE for occult and overt OGIB. Prospective studies showed a lower OR of rebleeding of .24 (95% CI, .08-.73; P = .01). Most studies were high quality. CONCLUSIONS: Our analysis shows that negative CE provides adequate evidence of a subsequently low risk of rebleeding. Such patients can therefore be safely managed with watchful waiting. However, patients who rebleed after 2 years may need to be investigated for a new source of blood loss. Crown
BACKGROUND AND AIMS: Small-bowel bleeding is the primary indication for capsule endoscopy (CE). Many experts advocate a "watch-and-wait" policy in negative CE. This meta-analysis examines the odds of rebleeding after negative index CE and the impact on long-term follow-up. METHODS: A comprehensive literature search identified articles examining the rebleeding rate after negative CE. Demographic and clinical information with emphasis on outcomes was retrieved, pooled, and analyzed. Heterogeneity among studies was assessed using the I2 statistic. A random effects model was used as the pooling method because of high heterogeneity. Risk of bias was assessed using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. The primary outcome evaluated was the pooled odds ratios (ORs) for rebleeding after a negative CE for obscure GI bleeding (OGIB). RESULTS: Twenty-six studies with 3657 patients were included. The pooled rate of rebleeding after negative CE was .19 (95% CI, .14-.25; P < .0001). The pooled OR of rebleeding was .59 (95% CI, .37-.95; P < .001). The effect was more pronounced in studies with a short follow-up (OR, .47; 95% CI, .24-.94; P < .001). There was no statistically significant difference in rebleeding after CE for occult and overt OGIB. Prospective studies showed a lower OR of rebleeding of .24 (95% CI, .08-.73; P = .01). Most studies were high quality. CONCLUSIONS: Our analysis shows that negative CE provides adequate evidence of a subsequently low risk of rebleeding. Such patients can therefore be safely managed with watchful waiting. However, patients who rebleed after 2 years may need to be investigated for a new source of blood loss. Crown
Authors: Bruno Rosa; Reuma Margalit-Yehuda; Kelly Gatt; Martina Sciberras; Carlo Girelli; Jean-Christophe Saurin; Pablo Cortegoso Valdivia; Jose Cotter; Rami Eliakim; Flavio Caprioli; Gunnar Baatrup; Martin Keuchel; Pierre Ellul; Ervin Toth; Anastasios Koulaouzidis Journal: Endosc Int Open Date: 2021-05-27