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'Watch-and-wait' safe after negative capsule endoscopy for small-bowel bleeding
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A negative capsule endoscopy result in patients with small-bowel bleeding is adequate for determining a low risk for subsequent rebleeding, according to the results of a systematic review and meta-analysis.
Researchers concluded that a “watch-and-wait” strategy is safe for managing these patients, although a new evaluation may be needed in patients who rebleed after 2 years.
“Our meta-analysis shows that for patients undergoing capsule endoscopy for small bowel bleeding, those with a negative result have an overall low rate of rebleeding — less than 20%,” Diana E. Yung, MBChB, of the Center for Liver and Digestive Disorders at the Royal Infirmary of Edinburgh, U.K., told Healio Gastroenterology. “The risk of rebleeding in this group is nearly half that of patients with positive small bowel capsule endoscopies, with an even lower risk in the first 2 years following the capsule endoscopy. This implies that patients with negative capsule endoscopies done to investigate small bowel bleeding can be safely managed with conservative measures, especially in the short-term.”
To determine the risk for rebleeding after a negative index SBCE and long-term outcomes, the investigators performed a comprehensive review of literature published up to 2016, and included 26 studies involving 3,657 patients in their analysis.
They found that the pooled rebleeding rate after a negative SBCE was 0.19 (95% CI, 0.14-0.25), the pooled rate of rebleeding after a positive SBCE was 0.29 (95% CI, 0.23-0.36), and the difference between the two was significant (P < .001).
The overall OR of rebleeding was 0.59 (95% CI, 0.37-0.95) after a negative vs. positive SBCE. Studies with a short follow-up demonstrated a stronger effect (OR = 0.47; 95% CI, 0.24-0.94).
Finally, the rate of rebleeding after CE was statistically comparable between occult and over OGIB, and prospectively designed studies showed a much lower risk for rebleeding after a negative CE (OR = 0.24; 95% CI, 0.08-0.73).
“Our analysis shows that a negative SBCE result in SB bleeding provides adequate evidence of a subsequently low risk of rebleeding,” the researchers concluded. “Such patients can therefore be safely managed with watchful waiting without further invasive investigations unless there is a change from occult to overt OGIB or a 4 g/dL drop in hemoglobin, as per ASGE guidelines.”
While CE “remains the investigation of choice for evaluating small-bowel bleeding,” the results of studies comparing CE to other diagnostic techniques for diagnosing OGIB have been mixed, Puneet Chhabra, MD, DM, and Deepak K. Bhasin, MD, DM, of the department of gastroenterology and hepatology at Fortis Hospital in India, wrote in a related editorial. “We await data on the role of magnetic and maneuverable capsules in OGIB to determine whether they will have a higher diagnostic value over conventional CE.” – by Adam Leitenberger
Disclosures: Some of the researchers report financial relationships with Given Imaging.
Editor's note: This article was updated on February 28 with comments from the study author.
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