NEED FOR ENTEROSCOPY IN OBSCURE DIGESTIVE HAEMORRHAGE: VALIDATION OF DISCRIMINATIVE SCORE

Aims:

Capsule endoscopy (CE) is the first-line diagnostic method in obscure GI bleeding (OGIB). Balloon-assisted enteroscopy may also be weighted, however, its use is not always necessary. Uchida et al. score recently described for enteroscopy need after CE for OGIB, includes the type of OGIB (occult/manifest), blood transfusion and CE findings. The present study aims to evaluate and validate the proposed score as discriminator for enteroscopy need in OGIB.

Methods:

Retrospective, unicentric study including all CE performed for OGIB between 2010 – 2017. Demographic, clinical and analytical data as well as CE reports were analyzed. The proposed score was calculated and acuity in patient selection for the need of enteroscopy was accessed. Enteroscopy was considered necessary according to the criteria established by Uchida et al.

Results:

207 patients were selected, 187 with OGIB. 54.0% (n = 101) were female, mean age 64.5 ± 15.1years. Mean hemoglobin 8.5 ± 2.1 g/dl. Occult OGIB was the indication for CE in 71.5% (n = 148), manifest OGIB in 28.5% (n = 59). Enteroscopy was considered necessary in 53.1% (n = 110). OGIB type, blood transfusion requirements and CE findings were significantly associated with the need for enteroscopy (p < 0.001). The score ranged from 0 – 7, with mean = 2.3 ± 1.9. The proposed cutoff of 2.5 allowed differentiation between patients requiring enteroscopy (p < 0.001), with sensitivity 78.4%, specificity 84.6%, positive predictive value 81.7% and negative predictive value 81.6%. Enteroscopy was required in 81.7% of patients with a score> 2.5 and 18.4% with a score< 2.5. The area under the ROC curve for predicting the need for enteroscopy was 0.81 (95% CI, 0.75 – 0.88, p < 0.001).

Conclusions:

The present data support the use of the score proposed by Uchida et al., through a cutoff of 2.5, as a predictor of the need for enteroscopy. It's use in OGIB may allow a more efficient patient management.