Antithrombotic Treatment Is Associated with Small-Bowel Video Capsule Endoscopy Positive Findings in Obscure Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis
The impact of antithrombotic treatment on the findings of small-bowel capsule endoscopy for patients with obscure gastrointestinal bleeding remains contentious. We aimed to determine the effect of these agents on small-bowel video capsule endoscopy positive findings.
MEDLINE, Cochrane Library, and Google Scholar were searched for studies reporting on patients receiving concurrent antithrombotic treatment, while undergoing capsule endoscopy for obscure gastrointestinal bleeding (OGIB). Outcomes were the effect of antithrombotic therapy—overall and per type of antithrombotic agent—on the examination’s positive findings and re-bleeding risk. The effect size of study outcomes is presented as odds ratio (OR) with 95% confidence interval (CI).
Fourteen studies with 1023 patients were included. We detected significant heterogeneity with no evidence of publication bias. Compared to antithrombotic drug nonusers, antithrombotic treatment was associated with an increased prevalence of positive findings [OR 1.98 (95% CI 1.34–2.93); P = 0.0006]. This effect did not differ between antiplatelet and anticoagulant treatments [OR 2.22 (95% CI 1.28–3.84); P = 0.005 and 2.53 (95% CI 1.66–3.87); P < 0.0001, respectively]. Antithrombotic use over no use was not associated either with overt [OR 1.17 (95% CI 0.51–2.66); P = 0.71] or with occult [OR 0.86 (95% CI 0.38–1.95); P = 0.71] bleeding pattern. However, concurrent antithrombotic treatment was associated with higher odds for re-bleeding compared to no treatment [OR 2.53 (95% CI 1.46–4.37); P = 0.0009].
Antithrombotic treatment is associated with more positive findings in small-bowel video capsule endoscopy in OGIB as well as higher odds of re-bleeding.
KeywordsCapsule endoscopy Obscure bleeding Antiplatelet Anticoagulant Re-bleeding
We acknowledge the contribution of Prof. Dr. Filiz Akyuz who kindly provided raw data of his study.
G Tziatzios and P Gkolfakis acquired the data, performed the meta-analysis, drafted, and finally approved the manuscript; Ioannis S. Papanikolaou revised the draft critically for important intellectual content and finally approved the manuscript; K Triantafyllou conceived the idea, revised the draft critically for important intellectual content, and finally approved the manuscript.
Compliance with ethical standards
All authors declare that they have no conflict of interests
- 13.Veitch AM, Vanbiervliet G, Gershlick AH, et al. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Endoscopy. 2016;48:385–402.CrossRefGoogle Scholar
- 18.Sidhu R, Sanders DS, Kapur K, Leeds JS, McAlindon ME. Factors predicting the diagnostic yield and intervention in obscure gastrointestinal bleeding investigated using capsule endoscopy. J Gastroint Liver Dis. 2009;18:273–278.Google Scholar
- 22.Boal Carvalho P, Rosa B, Moreira MJ, Cotter J. New evidence on the impact of antithrombotics in patients submitted to small bowel capsule endoscopy for the evaluation of obscure gastrointestinal bleeding. Gastroenterol Res Pract. 2013;2014:709217.Google Scholar