RHEMITT score: Predicting the risk of mid gastrointestinal rebleeding after small bowel capsule endoscopy: A prospective validation

• Published in: Journal of gastroenterology and hepatology 2022-02, Vol.37 (2), p.310-318
• Main Authors: Sousa Magalhães, Rui, Sousa‐Pinto, Bernardo, Boal Carvalho, Pedro, Rosa, Bruno, Moreira, Maria João, Cotter, José
• Format: Article
• Language: English
• Subjects: Aged; Bleeding; Capsule endoscopy; Capsule Endoscopy - adverse effects; Congestive heart failure; Coronary artery disease; Endoscopy; Female; Gastrointestinal Hemorrhage - epidemiology; Hemoglobin; Humans; Male; Middle Aged; Mid‐gastrointestinal bleeding; Patients; Prospective Studies; Rebleeding; Recurrence; Renal failure; Reproducibility of Results; Risk Assessment - methods; Small bowel; Small intestine; Surveillance
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/jgh.15695

Background and Aim The RHEMITT score (Renal disease; Heart failure; Endoscopic findings; Major bleeding; Incomplete SBCE; Tobacco; Treatment by enteroscopy) was the first score to accurately predict the individual risk of small bowel rebleeding after capsule endoscopy (SBCE). The aim of the study is on the prospective validation of the RHEMITT score. Methods Cohort of consecutive patients with mid‐gastrointestinal bleeding (MGIB) submitted to SBCE and followed prospectively, during at least 12 months, since 2017 until 2020. Rebleeding was defined as an overt bleeding event (melena or hematochezia) or a hemoglobin decrease of at least 2 g/dL. The RHEMITT score was calculated for each patient and the rebleeding rates compared. The performance of the score was tested by calculating the area under curve of the receiver operator characteristic curve. A rebleeding‐free survival was assessed, corresponding to the period between the date of SBCE and the date of the first post‐SBCE rebleeding event. Results We included 162 patients, 102 (62.9%) were female, with a mean age of 64 years old. The sensitivities and specificities of the score grades for predicting rebleeding were as following: for low‐risk patients, 0% (0–10%) and 28.8% (21.1–36.5%); for intermediate‐risk patients, 23.3% (8.2–38.4%) and 72% (64.3–79.7%); for high‐risk patients, 76.7% (61.6–91.8%) and 99.2% (97.7–100%), corresponding to an area under curve of the receiver operator characteristic of 0.988 (P