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Digestive Diseases and Sciences

, Volume 64, Issue 1, pp 15–24 | Cite as

Antithrombotic Treatment Is Associated with Small-Bowel Video Capsule Endoscopy Positive Findings in Obscure Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

  • Georgios Tziatzios
  • Paraskevas Gkolfakis
  • Ioannis S. Papanikolaou
  • Konstantinos TriantafyllouEmail author
Review

Abstract

Introduction

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.

Methods

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).

Results

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].

Conclusions

Antithrombotic treatment is associated with more positive findings in small-bowel video capsule endoscopy in OGIB as well as higher odds of re-bleeding.

Keywords

Capsule endoscopy Obscure bleeding Antiplatelet Anticoagulant Re-bleeding 

Notes

Acknowledgments

We acknowledge the contribution of Prof. Dr. Filiz Akyuz who kindly provided raw data of his study.

Author's contribution

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

Conflict interest

All authors declare that they have no conflict of interests

Supplementary material

10620_2018_5292_MOESM1_ESM.docx (21 kb)
Supplementary material 1 (DOCX 21 kb)
10620_2018_5292_MOESM2_ESM.docx (19 kb)
Supplementary material 2 (DOCX 18 kb)
10620_2018_5292_MOESM3_ESM.docx (131 kb)
Supplementary material 3 (DOCX 130 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Hepatogastroenterology Unit, Second Department of Internal Medicine – Propaedeutic Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens“Attikon” University General Hospital 1AthensGreece

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