Clinical features of obscure gastrointestinal bleeding undergoing capsule endoscopy: A retrospective cohort study

by Yuga Komaki, Shuji Kanmura, Kazuki Yutsudo, Kosuke Kuwazuru, Fukiko Komaki, Akihito Tanaka, Hidehito Maeda, Shiho Arima, Shiroh Tanoue, Fumisato Sasaki, Shinichi Hashimoto, Masahisa Horiuchi, Akio Ido

Capsule endoscopy has been widely used to investigate obscure gastrointestinal bleeding (OGIB) in the small intestine since its approval in 2001. However, the clinical features of OGIB remain unclear.

We retrospectively examined the clinical features and risk factors of OGIB in patients who underwent capsule endoscopy in our hospital.

We included 420 of the 431 patients who underwent capsule endoscopy from June 2014 to May 2021, in whom the small intestine could be observed. We retrospectively compared the clinical features and treatment of OGIB cases, with or without active small bowel bleeding (n = 173), with other cases (n = 247). Patient sex, age, diabetes mellitus, and heart failure histories were matched for the analysis.

The male/female ratio was 247/173 and the average age was 51.54 years. In multivariate analysis, the use of direct oral anticoagulants was significant (P = 0.016), and vascular lesions (P = 0.018) were observed in OGIB cases. When OGIB cases with and without active small bowel bleeding were compared, serum albumin level was lower in cases with active bleeding (P = 0.031). When treatment of OGIB cases were compared, those without vascular lesions could be treated conservatively (P = 0.0047). In the 1:1 propensity score matching analysis, serum creatinine level was elevated in cases of active bleeding (P = 0.029), and cases without vascular lesions were treated conservatively (P = 0.010).

Use of direct oral anticoagulants is frequently associated with OGIB. OGIB patients without vascular lesions may be treated conservatively.