The role of early video capsule endoscopy in the diagnosis and prognosis of obscure gastrointestinal bleeding: A multi‐center propensity score matching study

Background and Aim Video capsule endoscopy (VCE) is a first‐line procedure for the diagnosis of obscure gastrointestinal bleeding (OGIB). The opinions on the timing for such diagnostic evaluation remain unclear. We aimed to explore the role of early VCE in OGIB patients. Methods A total of 997 patie...

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Bibliographic Details
Published in:Journal of gastroenterology and hepatology 2021-09, Vol.36 (9), p.2540-2548
Main Authors: Zhao, Ran, Nakamura, Masanao, Wu, Shan, Uchida, Genta, Yamamura, Takeshi, Gao, Yun‐Jie, Goto, Hidemi, Fujishiro, Mitsuhiro, Ge, Zhi‐Zheng
Format: Article
Language:English
Subjects:
Aged
Bleeding
Capsule Endoscopy
Confidence intervals
Diagnosis
Endoscopy
Female
Gastrointestinal Hemorrhage - diagnosis
Gastrointestinal Hemorrhage - etiology
Humans
Male
Obscure gastrointestinal bleeding
Patients
Prognosis
Propensity Score
Propensity score matching
Recurrence
Reproducibility of Results
Retrospective Studies
Video capsule endoscopy
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Summary:Background and Aim Video capsule endoscopy (VCE) is a first‐line procedure for the diagnosis of obscure gastrointestinal bleeding (OGIB). The opinions on the timing for such diagnostic evaluation remain unclear. We aimed to explore the role of early VCE in OGIB patients. Methods A total of 997 patients that underwent VCE at Renji Hospital and Nagoya University from May 15, 2002, to December 28, 2016, were included in this study. We matched patients that underwent early VCE within 14 days of bleeding (early group, n = 678) to patients that did not (late group, n = 319) via 1:1 propensity score matching (PSM). We then compared VCE diagnostic rates and the prevalence of post‐VCE rebleeding in patients with initial negative VCE findings within 1 year between these groups before and after PSM. Results Following PSM, early VCE was associated with a significantly higher rate of OGIB diagnosis (56.4% vs 45.5%, P = 0.001) and with a significantly lower incidence of rebleeding within 1 year following treatment (24.7% vs 36.7%, P = 0.041). In univariate and multivariate analyses, VCE timing (odds ratio 0.648; 95% confidence interval 0.496–0.847, P = 0.001 and odds ratio 0.666; 95% confidence interval 0.496–0.894, P = 0.007, respectively) was found to be linked with a higher rate of positive findings. Conclusion Early VCE can improve the reliability of OGIB diagnosis while also reducing rates of post‐VCE rebleeding. This suggests that timely and accurate diagnosis can help to improve OGIB patient treatment and prognosis.
ISSN:0815-9319
1440-1746
DOI:10.1111/jgh.15491