The rebleeding rate in patients evaluated for obscure gastrointestinal bleeding after negative small bowel findings by device assisted enteroscopy.

BACKGROUND: data on the long-term outcome of patients with obscure gastrointestinal bleeding (OGIB) with positive small bowel findings in capsule endoscopy but negative small bowel findings in device-assisted enteroscopy are scarce. OBJECTIVE: this study aimed to evaluate the rebleeding rate and time to rebleed in patients with no small bowel findings in enteroscopy, after a positive capsule endoscopy in the setting of OGIB. Baseline predictors for rebleeding were assessed. METHODS: a retrospective double-center study was performed, including patients with OGIB with positive findings by capsule endoscopy and negative small bowel findings by enteroscopy. RESULTS: thirty-five patients were included. Rebleeding occurred in 40 % of patients during a median follow-up of 27 months. Further evaluation in patients with a rebleed was performed in 85.7 %, leading to a final diagnosis in 78.6 %. The rebleeding rate increased progressively over time, from 17.2 % at one month to 54.4 % at four years. Overt bleeding at the time of the first episode was a predictor of rebleeding (p = 0.03) according to the multivariate analysis. This was 50 % at one year compared with 21.8 % in patients with occult bleeding on admission. CONCLUSIONS: in obscure gastrointestinal bleeding, long-term follow-up and further evaluation may be considered after a positive capsule endoscopy. Even if there are no small bowel findings by device-assisted enteroscopy. The rebleeding rate in our study was 40 %, mainly in the presence of an overt bleeding on admission.

A case of a mixed adenoneuroendocrine tumor of the colon.

Neuroendocrine cells often coexist with exocrine neoplasms of the gut and each component is normally present in a variable range. Despite this frequent association, mixed exocrine-neuroendocrine carcinomas are rare. This entity is known as adenoneuroendocrine carcinoma (MANEC) and each of its malignant components represents at least 30%. In contrast, there are only a few reports of another rare association of an adenoma and a well differentiated neuroendocrine tumor (NET) in the colon and rectum. The term mixed adenoneuroendocrine tumor (MANET) was suggested due to its indolent behavior and distinct morphological characteristics with mild to moderate nuclear atypia and low number of mitoses1. However, it is not included in the recent World Health Organization (WHO) classification of tumors of the digestive system.