Suspected Small Bowel Bleeding

GOALS: We identified prognostic factors for mortality after Suspected small bowel bleeding (SSBB) and evaluated the impact of severe anemia and other clinical factors on patient survival. BACKGROUND: SSBB is characterized by an inability to identify the cause of bleeding despite esophagogastroduodenoscopy and colonoscopy. STUDY: This retrospective observational study included patients aged ≥20 years with SSBB who underwent capsule endoscopy (CE) at Hokkaido University Hospital in Japan from April 2015 to March 2022. Patient characteristics, blood transfusion history, CE results, blood test results, and post-CE mortality events were collected from electronic medical records. RESULTS: CE was performed in 99 patients to investigate the causes of SSBB, identifying bleeding sources in 40.4%. Over a median follow-up of 35 months (range: 0 to 94), mortality occurred in 34 cases. The overall 3-year survival rate was 71.1%. Multivariate analysis identified hemoglobin levels <8.0 g/dL [hazard ratio (HR)=9.75; 95% CI: 1.26-75.15; P=0.003] and end-stage cancer (HR=4.94; 95% CI: 2.02-12.10; P<0.001) as independent prognostic factors for mortality after CE for SSBB. Even after excluding patients with small bowel tumors and end-stage cancer, hemoglobin levels <8.0 g/dL (HR=5.07; 95% CI: 1.10-23.03; P=0.037) remained an independent predictor of mortality. The overall 5-year survival rates for patients without small bowel tumors and end-stage cancer in the groups with hemoglobin levels of ≥8.0 g/dL and <8.0 g/dL were 89.0% and 56.8%, respectively. CONCLUSION: Hemoglobin levels <8.0 g/dL significantly predict mortality in patients with SSBB.