{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:26:30Z","timestamp":1788780390955,"version":"build-2803163510"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,12,1]],"date-time":"2019-12-01T00:00:00Z","timestamp":1575158400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,12,16]],"date-time":"2019-12-16T00:00:00Z","timestamp":1576454400000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010804","name":"Faculty of Medicine, Prince of Songkla University","doi-asserted-by":"publisher","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"10.13039\/501100010804","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Capsule endoscopy (CE) is the preferred diagnostic test of choice in the investigation of obscure gastrointestinal bleeding (OGIB). Although, a conservative strategy is recommended in the short-term, for cases with a negative result from CE, the impact of CE on long-term re-bleeding still remains unclear. Hence, the aim of this study was to determine the long-term re-bleeding rate along with predictors after CE in patients with OGIB.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>We retrospectively reviewed 216 patients with OGIB, whom had received a CE examination, so as to investigate the cause of obscure GI bleeding; between July 2008 and March 2018. The patient\u2019s characteristics, medication use, CE finding, treatments strategy, re-bleeding episodes and follow-up information were collected from the institutional electronic medical chart and CE database. Re-bleeding free survival was evaluated using Kaplan-Meier curves with log rank test, whilst predictors associated with the re-bleeding episodes were analyzed via the use of Cox proportional hazard model.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>One hundred and thirty-three patients with OGIB, having received CE were enrolled in the analysis. The pool rate of re-bleeding was 26.3% (35\/133) during a follow-up duration of 26\u2009months after CE. Patients with positive CE study, without specific treatment, had higher rates of re-bleeding (47.6%) than those with positive study whom received specific treatment (25.7%), and negative study (20.8%) (<jats:italic>p<\/jats:italic>\u2009=\u20090.042). Although, the re-bleeding free survival was not significantly different among the groups (log rank test; <jats:italic>P<\/jats:italic>\u2009=\u20090.10). Re-bleeding events occurring within 6, 12, and 24\u2009months after CE were 36, 64 and 92%, respectively. The high-frequency re-bleeding etiologies were the small bowel angiodysplasias and abnormal vascular lesions. Furthermore, independent predictors for re-bleeding after CE were patients with cirrhosis (hazard ratio, HR 4.06), incomplete CE visualization (HR 2.97), and a history of previous GI bleeding (HR 2.80).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The likelihood of re-bleeding after CE was higher in patients with positive CE study than those with negative study. Specific treatments, or therapeutic interventions for patients with detectable lesions reduced the probability of re-bleeding episodes in long-term follow-up. Close follow-up for recurrent bleeding is recommeded for at least 2\u2009years after CE.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12876-019-1137-3","type":"journal-article","created":{"date-parts":[[2019,12,16]],"date-time":"2019-12-16T19:03:26Z","timestamp":1576523006000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Re-bleeding and its predictors after capsule endoscopy in patients with obscure gastrointestinal bleeding in long-term follow-up"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5962-4112","authenticated-orcid":false,"given":"Panu","family":"Wetwittayakhlang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jirapat","family":"Wonglhow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisa","family":"Netinatsunton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naichaya","family":"Chamroonkul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teerha","family":"Piratvisuth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,12,16]]},"reference":[{"issue":"3","key":"1137_CR1","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.dld.2012.07.012","volume":"45","author":"E Rondonotti","year":"2013","unstructured":"Rondonotti E, Marmo R, Petracchini M, de Franchis R, Pennazio M. The American Society for Gastrointestinal Endoscopy (ASGE) diagnostic algorithm for obscure gastrointestinal bleeding: eight burning questions from everyday clinical practice. Dig Liver Dis. 2013 Mar;45(3):179\u201385.","journal-title":"Dig Liver Dis"},{"issue":"5","key":"1137_CR2","doi-asserted-by":"publisher","first-page":"1697","DOI":"10.1053\/j.gastro.2007.06.007","volume":"133","author":"GS Raju","year":"2007","unstructured":"Raju GS, Gerson L, Das A, Lewis B. American Gastroenterological Association (AGA) institute technical review on obscure gastrointestinal bleeding. Gastroenterol. 2007 Nov;133(5):1697\u2013717.","journal-title":"Gastroenterol."},{"issue":"4","key":"1137_CR3","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1055\/s-2005-861114","volume":"37","author":"JC Saurin","year":"2005","unstructured":"Saurin JC, Delvaux M, Vahedi K, Gaudin JL, Villarejo J, Florent C, et al. Clinical impact of capsule endoscopy compared to push Enteroscopy: 1-year follow-up study. Endosc. 2005 Apr;37(4):318\u201323.","journal-title":"Endosc."},{"issue":"5","key":"1137_CR4","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1111\/j.1440-1746.2010.06530.x","volume":"26","author":"CW Teshima","year":"2011","unstructured":"Teshima CW, Kuipers EJ, van Zanten SV, Mensink PBF. Double balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding: an updated meta-analysis: meta-analysis: DBE versus CE for OGIB. J Gastroenterol Hepatol. 2011 May;26(5):796\u2013801.","journal-title":"J Gastroenterol Hepatol"},{"issue":"04","key":"1137_CR5","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1055\/s-0034-1391855","volume":"47","author":"M Pennazio","year":"2015","unstructured":"Pennazio M, Spada C, Eliakim R, Keuchel M, May A, Mulder C, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endosc. 2015 Mar 31;47(04):352\u201386.","journal-title":"Endosc."},{"issue":"6","key":"1137_CR6","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.1016\/j.gie.2008.06.054","volume":"68","author":"J Macdonald","year":"2008","unstructured":"Macdonald J, Porter V, McNamara D. Negative capsule endoscopy in patients with obscure GI bleeding predicts low rebleeding rates. Gastrointest Endosc. 2008 Dec;68(6):1122\u20137.","journal-title":"Gastrointest Endosc"},{"issue":"01","key":"1137_CR7","first-page":"59","volume":"46","author":"Y Min","year":"2013","unstructured":"Min Y, Kim J, Jeon S, Jeen Y, Im J, Cheung D, et al. Long-term outcome of capsule endoscopy in obscure gastrointestinal bleeding: a nationwide analysis. Endosc. 2013 Nov 19;46(01):59\u201365.","journal-title":"Endosc."},{"issue":"6","key":"1137_CR8","doi-asserted-by":"publisher","first-page":"990","DOI":"10.1016\/j.gie.2009.12.009","volume":"71","author":"JJ Park","year":"2010","unstructured":"Park JJ, Cheon JH, Kim HM, Park HS, Moon CM, Lee JH, et al. Negative capsule endoscopy without subsequent enteroscopy does not predict lower long-term rebleeding rates in patients with obscure GI bleeding. Gastrointest Endosc. 2010 May;71(6):990\u20137.","journal-title":"Gastrointest Endosc"},{"issue":"28","key":"1137_CR9","doi-asserted-by":"publisher","first-page":"4520","DOI":"10.3748\/wjg.v19.i28.4520","volume":"19","author":"ME Riccioni","year":"2013","unstructured":"Riccioni ME. Negative capsule endoscopy in patients with obscure gastrointestinal bleeding reliable: recurrence of bleeding on long-term follow-up. World J Gastroenterol. 2013;19(28):4520.","journal-title":"World J Gastroenterol"},{"issue":"8","key":"1137_CR10","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1097\/MEG.0000000000000135","volume":"26","author":"T C\u00fardia Gon\u00e7alves","year":"2014","unstructured":"C\u00fardia Gon\u00e7alves T, Dias de Castro F, Moreira MJ, Rosa B, Cotter J. Small bowel capsule endoscopy in obscure gastrointestinal bleeding: normalcy is not reassuring. Eur J Gastroenterol Hepatol. 2014 Aug;26(8):927\u201332.","journal-title":"Eur J Gastroenterol Hepatol"},{"issue":"5","key":"1137_CR11","first-page":"650","volume":"26","author":"T Matsumura","year":"2014","unstructured":"Matsumura T, Arai M, Saito K, Okimoto K, Saito M, Minemura S, et al. Predictive factor of re-bleeding after negative capsule endoscopy for obscure gastrointestinal bleeding: over 1-year follow-up study. Dig Endosc Off J Jpn Gastroenterol Endosc Soc. 2014 Sep;26(5):650\u20138.","journal-title":"Dig Endosc Off J Jpn Gastroenterol Endosc Soc"},{"issue":"4","key":"1137_CR12","doi-asserted-by":"publisher","first-page":"403","DOI":"10.4253\/wjge.v7.i4.403","volume":"7","author":"P Magalh\u00e3es-Costa","year":"2015","unstructured":"Magalh\u00e3es-Costa P, Bispo M, Santos S, Couto G, Matos L, Chagas C. Re-bleeding events in patients with obscure gastrointestinal bleeding after negative capsule endoscopy. World J Gastrointest Endosc. 2015;7(4):403.","journal-title":"World J Gastrointest Endosc"},{"issue":"3","key":"1137_CR13","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1111\/1751-2980.12222","volume":"16","author":"W Tan","year":"2015","unstructured":"Tan W, Ge ZZ, Gao YJ, Li XB, Dai J, Fu SW, et al. Long-term outcome in patients with obscure gastrointestinal bleeding after capsule endoscopy: outcomes of OGIB after CE. J Dig Dis. 2015 Mar;16(3):125\u201334.","journal-title":"J Dig Dis"},{"issue":"7","key":"1137_CR14","doi-asserted-by":"publisher","first-page":"344","DOI":"10.4253\/wjge.v8.i7.344","volume":"8","author":"A Ormeci","year":"2016","unstructured":"Ormeci A, Akyuz F, Baran B, Gokturk S, Ormeci T, Pinarbasi B, et al. What is the impact of capsule endoscopy in the long term period? World J Gastrointest Endosc. 2016;8(7):344.","journal-title":"World J Gastrointest Endosc."},{"issue":"5","key":"1137_CR15","doi-asserted-by":"publisher","first-page":"834","DOI":"10.1111\/jgh.12145","volume":"28","author":"J-B Kim","year":"2013","unstructured":"Kim J-B, Ye BD, Song Y, Yang D-H, Jung KW, Kim K-J, et al. Frequency of rebleeding events in obscure gastrointestinal bleeding with negative capsule endoscopy: Rebleeding after negative capsule. J Gastroenterol Hepatol. 2013 May;28(5):834\u201340.","journal-title":"J Gastroenterol Hepatol"},{"key":"#cr-split#-1137_CR16.1","doi-asserted-by":"crossref","unstructured":"Endo H, Matsuhashi N, Inamori M, Akimoto K, Ohya T, Yanagawa T, et al. Rebleeding rate after interventional therapy directed by capsule endoscopy in patients with obscure gastrointestinal bleeding. BMC Gastroenterol [Internet]. 2008 Dec;8","DOI":"10.1186\/1471-230X-8-12"},{"key":"#cr-split#-1137_CR16.2","unstructured":"(1) Available from: http:\/\/bmcgastroenterol.biomedcentral.com\/articles\/10.1186\/1471-230X-8-12[cited 23 Oct 2018]."},{"issue":"8","key":"1137_CR17","doi-asserted-by":"publisher","first-page":"2294","DOI":"10.1007\/s10620-009-1036-5","volume":"55","author":"M Esaki","year":"2010","unstructured":"Esaki M, Matsumoto T, Yada S, Yanaru-Fujisawa R, Kudo T, Yanai S, et al. Factors associated with the clinical impact of capsule endoscopy in patients with overt obscure gastrointestinal bleeding. Dig Dis Sci. 2010 Aug;55(8):2294\u2013301.","journal-title":"Dig Dis Sci"},{"issue":"10","key":"1137_CR18","doi-asserted-by":"publisher","first-page":"1632","DOI":"10.3748\/wjg.v19.i10.1632","volume":"19","author":"S-J Koh","year":"2013","unstructured":"Koh S-J. Long-term outcome in patients with obscure gastrointestinal bleeding after negative capsule endoscopy. World J Gastroenterol. 2013;19(10):1632.","journal-title":"World J Gastroenterol"},{"issue":"6","key":"1137_CR19","doi-asserted-by":"publisher","first-page":"1224","DOI":"10.1111\/j.1572-0241.2006.00565.x","volume":"101","author":"LH Lai","year":"2006","unstructured":"Lai LH, Wong GLH, Chow DKL, Lau JYW, Sung JJY, Leung WK. Long-term follow-up of patients with obscure gastrointestinal bleeding after negative capsule endoscopy. Am J Gastroenterol. 2006 Jun;101(6):1224\u20138.","journal-title":"Am J Gastroenterol"},{"issue":"3","key":"1137_CR20","doi-asserted-by":"publisher","first-page":"122","DOI":"10.4253\/wjge.v5.i3.122","volume":"5","author":"S Pongprasobchai","year":"2013","unstructured":"Pongprasobchai S. Yield, etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding. World J Gastrointest Endosc. 2013;5(3):122.","journal-title":"World J Gastrointest Endosc."},{"issue":"4","key":"1137_CR21","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1111\/jgh.13201","volume":"31","author":"R Niikura","year":"2016","unstructured":"Niikura R, Yamada A, Nagata N, Kobayashi Y, Okamoto M, Mitsuno Y, et al. New predictive model of rebleeding during follow-up of patents with obscure gastrointestinal bleeding: a multicenter cohort study: predictive model of rebleeding in OGIB. J Gastroenterol Hepatol. 2016 Apr;31(4):752\u201360.","journal-title":"J Gastroenterol Hepatol"},{"issue":"3","key":"1137_CR22","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1053\/j.gastro.2003.11.057","volume":"126","author":"M Pennazio","year":"2004","unstructured":"Pennazio M, Santucci R, Rondonotti E, Abbiati C, Beccari G, Rossini FP, et al. Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases. Gastroenterol. 2004 Mar;126(3):643\u201353.","journal-title":"Gastroenterol."},{"issue":"3","key":"1137_CR23","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1007\/s00535-004-1532-5","volume":"40","author":"G Bresci","year":"2005","unstructured":"Bresci G, Parisi G, Bertoni M, Tumino E, Capria A. The role of video capsule endoscopy for evaluating obscure gastrointestinal bleeding: usefulness of early use. J Gastroenterol. 2005 Apr 8;40(3):256\u20139.","journal-title":"J Gastroenterol"},{"key":"1137_CR24","doi-asserted-by":"crossref","unstructured":"Gomes C, Pinho R, Rodrigues A, Ponte A, Silva J, Rodrigues JP, et al. Impact of the timing of capsule endoscopy in overt obscure gastrointestinal bleeding on yield and rebleeding rate - is sooner than 14 d advisable? World J Gastrointest Endosc. 2018;10(4):74\u201382.","DOI":"10.4253\/wjge.v10.i4.74"},{"issue":"2","key":"1137_CR25","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1016\/j.gie.2016.08.027","volume":"85","author":"DE Yung","year":"2017","unstructured":"Yung DE, Koulaouzidis A, Avni T, Kopylov U, Giannakou A, Rondonotti E, et al. Clinical outcomes of negative small-bowel capsule endoscopy for small-bowel bleeding: a systematic review and meta-analysis. Gastrointest Endosc. 2017 Feb;85(2):305\u2013317.e2.","journal-title":"Gastrointest Endosc"},{"issue":"11","key":"1137_CR26","doi-asserted-by":"publisher","first-page":"551","DOI":"10.4253\/wjge.v5.i11.551","volume":"5","author":"A Ca\u00f1as-Ventura","year":"2013","unstructured":"Ca\u00f1as-Ventura A. Outcome in obscure gastrointestinal bleeding after capsule endoscopy. World J Gastrointest Endosc. 2013;5(11):551.","journal-title":"World J Gastrointest Endosc."},{"issue":"1","key":"1137_CR27","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.gie.2007.09.042","volume":"68","author":"P Hindryckx","year":"2008","unstructured":"Hindryckx P, Botelberge T, De Vos M, De Looze D. Clinical impact of capsule endoscopy on further strategy and long-term clinical outcome in patients with obscure bleeding. Gastrointest Endosc. 2008 Jul;68(1):98\u2013104.","journal-title":"Gastrointest Endosc"}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-019-1137-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12876-019-1137-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-019-1137-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,15]],"date-time":"2020-12-15T00:18:24Z","timestamp":1607991504000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgastroenterol.biomedcentral.com\/articles\/10.1186\/s12876-019-1137-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12]]},"references-count":28,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["1137"],"URL":"https:\/\/doi.org\/10.1186\/s12876-019-1137-3","relation":{},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12]]},"assertion":[{"value":"25 May 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 December 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 December 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was reviewed and approved by the Human Research Ethics Committee of the Faculty of Medicine, Prince of Songkla University.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All other authors have no conflict of interest to disclose. The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"216"}}