The role of early video capsule endoscopy in the diagnosis and prognosis of obscure gastrointestinal bleeding: a multi-center propensity score matching study.

Background and aim Video capsule endoscopy (VCE) is a first-line procedure for the diagnosis of obscure gastrointestinal bleeding (OGIB). The opinions on the timing for such diagnostic evaluation remain unclear. We aimed to explore the role of early VCE in OGIB patients. Methods We used 997 total patients in this study that underwent VCE at Renji Hospital and Nagoya University from May 15, 2002, through December 28, 2016 were included in this study. We matched patients that underwent early VCE within 14 days of bleeding (early group, n= 678) to patients that did not (late group, n= 319) via 1:1 propensity score matching (PSM). We then compared VCE diagnostic rates and the prevalence of post-VCE re-bleeding in patients with initial negative VCE findings within one year between these groups before and after PSM. Results Following PSM, early VCE was associated with a significantly higher rate of OGIB diagnosis (56.4% vs. 45.5%, P=0.001) and with a significantly lower incidence of re-bleeding within 1-year following treatment (24.7% vs. 36.7%, P=0.041). In univariate and multivariate analyses, VCE timing (OR 0.648; 95% CI 0.496-0.847, P=0.001 and OR 0.666; 95% CI 0.496 - 0.894, P=0.007, respectively) was found to be linked with a higher rate of positive findings. Conclusion Early VCE can improve the reliability of OGIB diagnosis while also reducing rates of post-VCE re-bleeding. This suggests that timely and accurate diagnosis can help to improve OGIB patient treatment and prognosis.