Etiology and long-term rebleeding of endoscopic ulcerative lesions in the small bowel in patients with obscure gastrointestinal bleeding: A multicenter cohort study.
BACKGROUND
Among patients with obscure gastrointestinal bleeding (OGIB), endoscopic ulcerative lesions in the small bowel have diverse etiologies and often cause rebleeding. Certain characteristics of patients or ulcerations may be reasonable indications for diagnostic balloon-assisted endoscopy (BAE) to assess etiology and may be risks of rebleeding; however, these characteristics are unclear. We aimed to elucidate appropriate indications for diagnostic BAE and predictors of long-term rebleeding in patients with small bowel ulcerative lesions.


METHODS
We conducted a multicenter retrospective cohort study of 68 patients with OGIB, in whom small bowel ulcerative lesions were detected by capsule endoscopy (n = 60) and/or BAE (n = 43). Patients' characteristics, including medications and endoscopic findings, were evaluated. Predictors of the need for diagnostic BAE to determine ulceration etiology were identified by logistic regression analysis. Rebleeding risks were evaluated using Cox proportional hazards analysis.


RESULTS
Single ulcerations were diagnosed in 26 patients, and multiple ulcerations were diagnosed in 42 patients. Among 43 patients who underwent BAE, ulceration etiology was identified in 12 (28%) patients. In the etiology identification, BAE was more useful for a single ulceration than for multiple ulcerations (P < 0.001). Among the 68 patients, rebleeding occurred in 14 (21%) patients during a mean follow-up period of 17 months. Aspirin use and multiple ulcerations were significant predictors of rebleeding (P < 0.05).


CONCLUSIONS
When we manage small bowel ulcerative lesions in OGIB patients, a single ulceration is a reasonable indication for the diagnostic BAE. The rebleeding rate was lower for single ulcerations than for multiple ulcerations.
['Aoki|Tomonori|T|', 'Yamada|Atsuo|A|http://orcid.org/0000-0003-4314-7777', 'Hirata|Yoshihiro|Y|', 'Suzuki|Hirobumi|H|', 'Nakada|Ayako|A|', 'Niikura|Ryota|R|', 'Seto|Motoko|M|', 'Okamoto|Makoto|M|', 'Koike|Kazuhiko|K|']
D000368:Aged D001241:Aspirin D053704:Capsule Endoscopy D015331:Cohort Studies D016099:Endoscopy, Gastrointestinal D005260:Female D005500:Follow-Up Studies D005544:Forecasting D006801:Humans D007421:Intestine, Small D016015:Logistic Models D008297:Male D010438:Peptic Ulcer Hemorrhage D016016:Proportional Hazards Models D012008:Recurrence D012189:Retrospective Studies
etiology rebleeding diagnostic balloon-assisted endoscopy single ulceration multiple ulcerations aspirin