The predictive value of negative capsule endoscopy for the indication of Obscure Gastrointestinal Bleeding: no reassurance in the long term

Background and aims : Capsule Endoscopy (CE) has become the first-line tool to identify an underlying etiology for Obscure Gastrointestinal Bleeding (OGIB) in the small bowel (SB). This study aims to investigate the long-term outcome of patients with a negative CE. Patients and methods : Retrospective review of standardized application forms of all patients who underwent CE for OGIB at the Ghent University Hospital between 2002 and 2013. Follow-up data on patients with a negative CE result (n = 263) were collected by contacting the referring physician. Results : Follow-up was available for 211 patients (Male, n = 107; Female, n = 104; Overt bleeding, n = 76; Occult bleeding, n = 135). Median follow-up time was 51.7 months (range 1.4-139.6 months). Ninety-six patients underwent further diagnostics, showing a cause for OGIB in 57 (59.4%). Final outcome for the complete cohort of negative CEs was : 139 (65.9%) true negative (i.e. non-SB cause of bleeding/resolved OGIB), 19 (9%) false negative (i.e. SB cause of OGIB) and 53 (25.1%) ongoing bleeding without cause. Missed SB lesions were : angiodysplasia (n = 11), Meckel's diverticulum (n = 3), SB malignancy (n = 3), jejunal erosions (n = 1) and NSAID-induced SB ulcerations (n = 1). Bleeding resolved in 138/209 patients (66%) of which 79 underwent non-specific therapy. Conclusions : Negative CEs in patients with OGIB do not reassure the treating physician, but warrant close monitoring. In suspicious cases, alternative diagnostic modalities are recommended, showing a high diagnostic yield.