Video capsule endoscopy for previous overt obscure gastrointestinal bleeding in patients using anti-thrombotic drugs

• Published in: Digestive endoscopy 2012-07, Vol.24 (4), p.247-254
• Main Authors: Van Weyenberg, Stijn JB, Van Turenhout, Sietze T, Jacobs, Maarten AJM, Bouma, Gerd, Mulder, Chris JJ
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Angiodysplasia - complications; anti-thrombotic therapy; Capsule Endoscopy; Female; Fibrinolytic Agents - adverse effects; Fibrinolytic Agents - therapeutic use; Gastrointestinal Hemorrhage - diagnosis; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Tract - blood supply; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; obscure gastrointestinal bleeding; Retrospective Studies; small intestine; video capsule endoscopy
• ISSN: 0915-5635; 1443-1661
• DOI: 10.1111/j.1443-1661.2011.01228.x

Background and Aim:  Little is known about the causes of overt obscure gastrointestinal bleeding (OGIB) in patients using anti‐thrombotic therapy. We aimed to describe video capsule endoscopy (VCE) findings and to identify factors associated with positive findings in these patients. Methods:  We carried out a retrospective study of 56 patients who underwent VCE for evaluation of previous overt OGIB during anti‐thrombotic therapy. VCE studies were re‐evaluated by a gastroenterologist blinded to clinical details. Clinical data included in the multivariate analysis were sex, age, indication for and type of anti‐thrombotic therapy, hemodynamic instability on admission, type of blood loss, hemoglobin on admission, use of a proton pump inhibitor, NSAID use, time between bleeding episodes and VCE, and whether or not anti‐thrombotic therapy was resumed before the VCE study. Results:  A probable cause for gastrointestinal bleeding was identified in 28 (50%) of the 56 studies. Angiodysplasia was found in 19 patients. Twenty‐two studies showed a possible cause in the small bowel. Multivariate logistic regression analysis showed that reinstitution of anti‐thrombotic therapy before VCE was carried out was the only independent predictor of positive VCE findings (OR: 8.61, 95% CI: 1.20–60.42, P = 0.032). Conclusions:  Small intestinal angiodysplasia was the most common cause for overt OGIB. Reinstitution of withdrawn anti‐thrombotic drugs before the VCE examination was carried out was associated with positive VCE findings in multivariate analysis.