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Clinical outcomes of negative small-bowel capsule endoscopy for small-bowel bleeding : A systematic review and meta-analysis

Yung, Diana E.; Koulaouzidis, Anastasios LU ; Avni, Tomer; Kopylov, Uri; Giannakou, Andry; Rondonotti, Emanuele; Pennazio, Marco; Eliakim, Rami; Toth, Ervin LU and Plevris, John N. (2017) In Gastrointestinal Endoscopy 85(2). p.2-317
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)... (More)

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.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Gastrointestinal Endoscopy
volume
85
issue
2
pages
2 - 317
publisher
Mosby
external identifiers
  • scopus:85006062988
  • wos:000397169100004
ISSN
0016-5107
DOI
10.1016/j.gie.2016.08.027
language
English
LU publication?
yes
id
728a03ac-45a4-4631-ac6e-c981f95e54d6
date added to LUP
2016-12-30 09:29:55
date last changed
2018-05-06 04:29:27
@article{728a03ac-45a4-4631-ac6e-c981f95e54d6,
  abstract     = {<p>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 I<sup>2</sup> 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 &lt; .0001). The pooled OR of rebleeding was .59 (95% CI, .37-.95; . P &lt; .001). The effect was more pronounced in studies with a short follow-up (OR, .47; 95% CI, .24-.94; . P &lt; .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.</p>},
  author       = {Yung, Diana E. and Koulaouzidis, Anastasios and Avni, Tomer and Kopylov, Uri and Giannakou, Andry and Rondonotti, Emanuele and Pennazio, Marco and Eliakim, Rami and Toth, Ervin and Plevris, John N.},
  issn         = {0016-5107},
  language     = {eng},
  number       = {2},
  pages        = {2--317},
  publisher    = {Mosby},
  series       = {Gastrointestinal Endoscopy},
  title        = {Clinical outcomes of negative small-bowel capsule endoscopy for small-bowel bleeding : A systematic review and meta-analysis},
  url          = {http://dx.doi.org/10.1016/j.gie.2016.08.027},
  volume       = {85},
  year         = {2017},
}