A team from Paris, France, assessed the rate of recurrent bleeding and its predictive factors in patients with gastrointestinal bleeding of obscure origin, after exploration by push enteroscopy.
A total of 105 patients with gastrointestinal bleeding of obscure origin (iron-deficiency anemia: n = 56; overt bleeding: n = 49) were included in the study.
All underwent investigation by push enteroscopy from December 1994 to December 1998.
The patients were classified into three groups according to enteroscopy findings. These were no lesion found (Group A; 56 patients), arteriovenous malformations (Group B; 18 patients), and other gastrointestinal lesions (Group C; 31 patients).
Actuarial rates of rebleeding during follow-up were calculated.
In addition, factors associated with rebleeding were assessed by means of univariate and multivariate analysis.
Follow-up data were obtained for 96% of the individuals, with a mean follow-up of 29 months.
No lesion: 28%
Arteriovenous malformation: 56%
Other GI lesions: 24%
| Endoscopy |
The 2-year actuarial rate of rebleeding was 31% in the overall population. The rates were 28%, 56%, and 24% in Groups A, B, and C, respectively.
The researchers found that the number of previous bleeding episodes and the number of packed red cell units transfused were two independent factors predictive of recurrent bleeding.
The modality of recurrent bleeding (anemia or overt bleeding) was similar to that of the initial episode in 94% of cases.
In Group A, a gastrointestinal lesion was found after rebleeding in 1 of the 12 patients with iron-deficiency anemia, and in 4 of the 5 patients with overt bleeding.
Author B. Landi, of the Georges Pompidou European Hospital, in Paris, said on behalf of the group, "Recurrent bleeding occurs in about one-third of patients who undergo investigation by push enteroscopy for gastrointestinal bleeding of obscure origin.
"There is a trend towards more frequent rebleeding in patients with arteriovenous malformations."
"Frequent previous bleeding episodes and transfusion requirements are predictive of recurrent bleeding," it was concluded.