Introduction: Deciding which patients with suspected small bowel bleeding (SSB) would benefit most from small bowel capsule endoscopy (SBCE) is challenging. Our aim was to perform an external validation of the recently developed SSB Capsule Diagnostic (Dx) score that includes 3 variables (hospital admission with overt bleeding, hemoglobin <6.4 g/dL and age <54 years) and has been shown to be potentially useful in limiting the use of SBCE in SSB low-risk patients. Methods: Retrospectively included all adult patients submitted to SBCE for SSB between November 2007 and December 2019. Patients’ demographic, clinical and laboratorial data at the time of SBCE were recorded. Small bowel lesions were classified according to Saurin classification. The SSB Capsule Dx score was calculated, and its calibration and discrimination ability were assessed. Results: We assessed 473 SBCEs for SSB. Patients’ mean age was 61.2 ± 17.9 years and 65.8% were female. P2 lesions were present in 36.2% of SBCEs. There was a significant association between the score and P2 lesions (p < 0.001). Mean score was −0.21 ± 0.87 having a fair accuracy toward the outcome (C-statistic 0.700; 95% confidence interval, 0.652–0.749; p < 0.001). A cutoff value of 0 was found to have a high sensitivity (86.0%) and negative predictive value (84.9%) for the diagnosis of P2 lesions at SBCE. Conclusion: Patients with a SSB Capsule Dx score <0 are unlikely to have a significant lesion on SBCE, thus its routine use in the clinical practice may be useful in the identification of low-risk SSB patients.

1.
Rockey
DC
.
Occult gastrointestinal bleeding
.
N Engl J Med
.
1999
;
341
(
1
):
38
46
.
2.
Gerson
LB
,
Fidler
JL
,
Cave
DR
,
Leighton
JA
.
ACG clinical guideline: diagnosis and management of small bowel bleeding
.
Am J Gastroenterol
.
2015
;
110
(
9
):
1265
88
.
3.
Enns
RA
,
Hookey
L
,
Armstrong
D
,
Bernstein
CN
,
Heitman
SJ
,
Teshima
C
, et al
.
Clinical practice guidelines for the use of video capsule endoscopy
.
Gastroenterology
.
2017
;
152
(
3
):
497
514
.
4.
Ko
CW
,
Siddique
SM
,
Patel
A
,
Harris
A
,
Sultan
S
,
Altayar
O
, et al
.
AGA clinical practice guidelines on the gastrointestinal evaluation of iron deficiency anemia
.
Gastroenterology
.
2020
;
159
(
3
):
1085
94
.
5.
Pennazio
M
,
Rondonotti
E
,
Despott
EJ
,
Dray
X
,
Keuchel
M
,
Moreels
T
, et al
.
Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline–update 2022
.
Endoscopy
.
2023
;
55
(
1
):
58
95
.
6.
Saperas
E
,
Dot
J
,
Videla
S
,
Alvarez-Castells
A
,
Perez-Lafuente
M
,
Armengol
JR
, et al
.
Capsule endoscopy versus computed tomographic or standard angiography for the diagnosis of obscure gastrointestinal bleeding
.
Am J Gastroenterol
.
2007
;
102
(
4
):
731
7
.
7.
Wang
Z
,
Chen
JQ
,
Liu
JL
,
Qin
XG
,
Huang
Y
.
CT enterography in obscure gastrointestinal bleeding: a systematic review and meta-analysis
.
J Med Imaging Radiat Oncol
.
2013
;
57
(
3
):
263
73
.
8.
Triester
SL
,
Leighton
JA
,
Leontiadis
GI
,
Fleischer
DE
,
Hara
AK
,
Heigh
RI
, et al
.
A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding
.
Am J Gastroenterol
.
2005
;
100
(
11
):
2407
18
.
9.
Laine
L
,
Sahota
A
,
Shah
A
.
Does capsule endoscopy improve outcomes in obscure gastrointestinal bleeding? Randomized trial versus dedicated small bowel radiography
.
Gastroenterology
.
2010
;
138
(
5
):
1673
e12
; quiz e11-2.
10.
Leung
WK
,
Ho
SS
,
Suen
BY
,
Lai
LH
,
Yu
S
,
Ng
EK
, et al
.
Capsule endoscopy or angiography in patients with acute overt obscure gastrointestinal bleeding: a prospective randomized study with long-term follow-up
.
Am J Gastroenterol
.
2012
;
107
(
9
):
1370
6
.
11.
Wiarda
BM
,
Heine
DG
,
Mensink
P
,
Stolk
M
,
Dees
J
,
Hazenberg
HJ
, et al
.
Comparison of magnetic resonance enteroclysis and capsule endoscopy with balloon-assisted enteroscopy in patients with obscure gastrointestinal bleeding
.
Endoscopy
.
2012
;
44
(
7
):
668
73
.
12.
de Leusse
A
,
Vahedi
K
,
Edery
J
,
Tiah
D
,
Fery-Lemonnier
E
,
Cellier
C
, et al
.
Capsule endoscopy or push enteroscopy for first-line exploration of obscure gastrointestinal bleeding
.
Gastroenterology
.
2007
;
132
(
3
):
855
1165
; quiz 1164-5.
13.
Shim
KN
,
Moon
JS
,
Chang
DK
,
Do
JH
,
Kim
JH
,
Min
BH
, et al
.
Guideline for capsule endoscopy: obscure gastrointestinal bleeding
.
Clin Endosc
.
2013
;
46
(
1
):
45
53
.
14.
Hartmann
D
,
Schmidt
H
,
Bolz
G
,
Schilling
D
,
Kinzel
F
,
Eickhoff
A
, et al
.
A prospective two-center study comparing wireless capsule endoscopy with intraoperative enteroscopy in patients with obscure GI bleeding
.
Gastrointest Endosc
.
2005
;
61
(
7
):
826
32
.
15.
Kim
SH
,
Yang
DH
,
Kim
JS
.
Current status of interpretation of small bowel capsule endoscopy
.
Clin Endosc
.
2018
;
51
(
4
):
329
33
.
16.
Pasha
SF
,
Leighton
JA
.
Evidence-Based guide on capsule endoscopy for small bowel bleeding
.
Gastroenterol Hepatol
.
2017
;
13
(
2
):
88
93
.
17.
Kwack
WG
,
Lim
YJ
.
Current status and research into overcoming limitations of capsule endoscopy
.
Clin Endosc
.
2016
;
49
(
1
):
8
15
.
18.
Chetcuti Zammit
S
,
Sidhu
R
.
Capsule endoscopy: recent developments and future directions
.
Expert Rev Gastroenterol Hepatol
.
2020
;
15
(
2
):
127
37
.
19.
Rondonotti
E
,
Soncini
M
,
Girelli
C
,
Villa
F
,
Russo
A
,
de Franchis
R
, et al
.
Cost estimation of small bowel capsule endoscopy based on “real world” data: inpatient or outpatient procedure
.
Dig Liver Dis
.
2010
;
42
(
11
):
798
802
.
20.
Albrecht
H
,
Vetter
M
,
Dauth
W
,
Zoicas
F
,
Neurath
MF
,
Hagel
AF
.
The impact of hospitalization on the performance of capsule endoscopy (CE)
.
Dig Liver Dis
.
2017
;
49
(
6
):
647
50
.
21.
Yazici
C
,
Losurdo
J
,
Brown
MD
,
Oosterveen
S
,
Rahimi
R
,
Keshavarzian
A
, et al
.
Inpatient capsule endoscopy leads to frequent incomplete small bowel examinations
.
World J Gastroenterol
.
2012
;
18
(
36
):
5051
7
.
22.
Westerhof
J
,
Weersma
RK
,
Koornstra
JJ
.
Risk factors for incomplete small-bowel capsule endoscopy
.
Gastrointest Endosc
.
2009
;
69
(
1
):
74
80
.
23.
Bresci
G
,
Parisi
G
,
Bertoni
M
,
Tumino
E
,
Capria
A
.
The role of video capsule endoscopy for evaluating obscure gastrointestinal bleeding: usefulness of early use
.
J Gastroenterol
.
2005
;
40
(
3
):
256
9
.
24.
Katsinelos
P
,
Chatzimavroudis
G
,
Terzoudis
S
,
Patsis
I
,
Fasoulas
K
,
Katsinelos
T
, et al
.
Diagnostic yield and clinical impact of capsule endoscopy in obscure gastrointestinal bleeding during routine clinical practice: a single-center experience
.
Med Princ Pract
.
2011
;
20
(
1
):
60
5
.
25.
Singh
A
,
Marshall
C
,
Chaudhuri
B
,
Okoli
C
,
Foley
A
,
Person
SD
, et al
.
Timing of video capsule endoscopy relative to overt obscure GI bleeding: implications from a retrospective study
.
Gastrointest Endosc
.
2013
;
77
(
5
):
761
6
.
26.
Marya
NB
,
Wang
L
,
Dasharathy
S
,
Cusumano
VT
,
Dong
T
,
Fejleh
MP
, et al
.
Development of a scoring system to predict a positive diagnosis on video capsule endoscopy for suspected small bowel bleeding
.
Tech Innov Gastrointest Endosc
.
2020
;
22
(
4
):
178
84
.
27.
Collins
GS
,
Reitsma
JB
,
Altman
DG
,
Moons
KG
.
Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD Statement
.
Eur J Clin Invest
.
2015
;
45
(
2
):
204
14
.
28.
Korman
LY
,
Delvaux
M
,
Gay
G
,
Hagenmuller
F
,
Keuchel
M
,
Friedman
S
, et al
.
Capsule endoscopy structured terminology (CEST): proposal of a standardized and structured terminology for reporting capsule endoscopy procedures
.
Endoscopy
.
2005
;
37
(
10
):
951
9
.
29.
Saurin
JC
,
Delvaux
M
,
Gaudin
JL
,
Fassler
I
,
Villarejo
J
,
Vahedi
K
, et al
.
Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: blinded comparison with video push-enteroscopy
.
Endoscopy
.
2003
;
35
(
7
):
576
84
.
30.
Lepileur
L
,
Dray
X
,
Antonietti
M
,
Iwanicki-Caron
I
,
Grigioni
S
,
Chaput
U
, et al
.
Factors associated with diagnosis of obscure gastrointestinal bleeding by video capsule enteroscopy
.
Clin Gastroenterol Hepatol
.
2012
;
10
(
12
):
1376
80
.
31.
Olano
C
,
Pazos
X
,
Avendano
K
,
Calleri
A
,
Ketzoian
C
.
Diagnostic yield and predictive factors of findings in small-bowel capsule endoscopy in the setting of iron-deficiency anemia
.
Endosc Int Open
.
2018
;
6
(
6
):
E688
93
.
32.
Nennstiel
S
,
Machanek
A
,
von Delius
S
,
Neu
B
,
Haller
B
,
Abdelhafez
M
, et al
.
Predictors and characteristics of angioectasias in patients with obscure gastrointestinal bleeding identified by video capsule endoscopy
.
United Eur Gastroenterol J
.
2017
;
5
(
8
):
1129
35
.
33.
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 Gastrointestin Liver Dis
.
2009
;
18
(
3
):
273
8
.
34.
Carey
EJ
,
Leighton
JA
,
Heigh
RI
,
Shiff
AD
,
Sharma
VK
,
Post
JK
, et al
.
A single-center experience of 260 consecutive patients undergoing capsule endoscopy for obscure gastrointestinal bleeding
.
Am J Gastroenterol
.
2007
;
102
(
1
):
89
95
.
35.
Curdia Goncalves
T
,
Magalhaes
J
,
Boal Carvalho
P
,
Moreira
MJ
,
Rosa
B
,
Cotter
J
.
Is it possible to predict the presence of intestinal angioectasias
.
Diagn Ther Endosc
.
2014
;
2014
:
461602
.
36.
Alba
AC
,
Agoritsas
T
,
Walsh
M
,
Hanna
S
,
Iorio
A
,
Devereaux
PJ
, et al
.
Discrimination and calibration of clinical prediction models: users’ guides to the medical literature
.
JAMA
.
2017
;
318
(
14
):
1377
84
.
37.
Spada
C
,
McNamara
D
,
Despott
EJ
,
Adler
S
,
Cash
BD
,
Fernandez-Urien
I
, et al
.
Performance measures for small-bowel endoscopy: a European society of gastrointestinal endoscopy (ESGE) quality improvement initiative
.
Endoscopy
.
2019
;
51
(
6
):
574
98
.
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