The Comparison Of Diagnostic Value Of Second-look Capsule Endoscopy Or Balloon Enteroscopy For Re-bleeding In Obscure Gastrointestinal Bleeding Patients With Negative Findings

Background Bleeding from the small intestine remains a relatively uncommon event,accounting for 5~10% of all patients presenting with gastrointestinal(GI)bleeding.Given advances in small bowel imaging with capsule endoscopy(CE),deep enteroscopy,and radiographic imaging,the cause of bleeding in the small bowel can now be identified in most patients.In 2015,ACG clinical guideline:diagnosis and management of small bowel bleeding point out that patients with gastrointestinal bleeding whose upper and lower gastrointestinal endoscopy(gastroscopy,colonoscopy)were all negative should be diagnosed as having a potential small bowel bleeding.The term potential small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding(OGIB).The term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract.If the patient fails to identify the cause after performing upper and lower gastrointestinal endoscopy,the cause of small bowel bleeding should be considered.Overt small bowel bleeding refers to visible bleeding(eg,melena or hematochezia),whereas occult small bowel bleeding refers to cases of fecal occult blood positivity and/or unexplained iron deficiency anemia.The guideline point out that CE should be considered a first-line procedure for small bowel(SB)evaluation after upper and lower GI sources have been excluded.If the CE results are negative,conservative treatment can be temporarily given.At present,there is little research at home and abroad to compare the diagnostic value of capsule endoscopy or balloon enteroscopy for re-bleeding in potential small-bowel bleeding patients with negative findings.Object The purpose of this study was to analyze the diagnostic value of capsule endoscopy or balloon enteroscopy for re-bleeding in potential small-bowel bleeding patients with negative findings.Methods The patients with potential small-bowel bleeding whose endoscopy,colonoscopy,abdominal CT,and capsule endoscopy were all negative in the First Affiliated Hospital of Zhengzhou University from Jan.2011 to Dec.2013.Retrospective analysis of patient-related clinical data,101 cases of patients with negative CE were followed up for 3 to 24 months to determine rebleeding events.Rebleeding events occurred during the follow-up of patients with negative capsule endoscopy.The patient's age,gender,indications,positive rate,and type of lesion detected by CE or deep enteroscopy.Results 1.This study consisted of 215 patients with potential small-bowel bleeding whose endoscopy,colonoscopy,abdominal CT,were all negative and successfully completed capsule endoscopy were analyzed retrospectively.114 patients(53.02%)were positive for VCE,including angiodysplasia(n=43,37.72%),ulcers(n=32,28.07%),neoplastic lesions(n=23,20.18%),small bowel parasites(n=9,7.89%),diverticulum(n=7,6.14%).101 patients(47.98%)were negative for CE,15 patients were followed by further CTE,MRE,or balloon enteroscopy.86 patients with negative capsule endoscopy refused further examination,given nonspecific treatment,and followed up closely.2.Among the patients with rebleeding,14 patients were positive in the CE group,5 patients were negative,the positive rate was 73.68%,8 patients w ere positive in balloon enteroscopy group,14 patients were negative and the p ositive rate was 36.36%.The positive rate of second CE was higher than balloon enteroscopy and the difference is statistically significant(P=0.017).T here were 14 positive patients in CE group,including angiodysplasia(n=7,50.00%),ulcers(n=4,28.58%),neoplastic lesions(n=1,7.14%),small bowel parasites(n=1,7.14%),intestinal lymphatic distention(n=1,7.14%).There were 8 patients of positive balloon enteroscopy,including angiodysplasia(n=2,25.00%),ulcers(n=2,25.00%),neoplastic lesions(n=3,37.50%),diverticulum(n=1,12.5%).3.In 128 patients who underwent CE,the small bowel lesions were located in the jejunum in 65 patients(50.78%),in the ileum in 48 patients(37.50%),angiodysplasia and in the jejunum and ileum in 15 patients(11.72%).and neoplastic lesions are mostly located in the jejunum.Small bowel parasites and diverticulum are mostly located in the ileum.Small bowel ulcer lesions have a close distribution in the jejunum and ileum.Concludes 1.Obscure gastrointestinal bleeding patients with negative findings in CE still have a certain risk of rebleeding.It is recommended that those patients should be close followed up,and small bowel related examinations should be promptly improved after rebleeding.2.The rate of recaptured repeated capsule endoscopy in patients with negative capsule endoscopy was higher than the detection rate of small intestine endoscopy.Repeated capsule endoscopy was more valuable for the diagnosis of the disease after rebleeding occurred in patients with a negative capsule endoscopy.