Risk Stratification for Rebleeding in Obscure Gastrointestinal Bleeding After Comprehensive Gastrointestinal Evaluation.

Background and Aim: Obscure gastrointestinal bleeding (OGIB) is defined as bleeding of unknown origin after comprehensive upper, lower, and small-bowel evaluations. However, the incidence and predictors of rebleeding after negative comprehensive gastrointestinal evaluation remain unclear. We aimed to identify predictors of rebleeding and develop a simple risk stratification score for OGIB.

Methods

We retrospectively analyzed 226 patients diagnosed with OGIB between 2009 and 2024. The primary outcome was rebleeding during follow-up. Independent predictors were identified using multivariable Cox proportional hazards analysis. A risk score was constructed from regression coefficients and evaluated using receiver operating characteristic analysis and Kaplan-Meier curves.

Results

Among 226 patients, 87 (38.5%) had overt OGIB and 139 (61.5%) had occult OGIB. Rebleeding occurred in 30 (13.2%) patients. Multivariable analysis identified liver cirrhosis (β = 0.59, p < 0.01), overt OGIB (β = 0.69, p < 0.01), and aspirin use (β = 0.51, p = 0.02) as independent predictors. Each factor was assigned one point, yielding a 0-3 point score. The score showed modest discriminative ability (area under the curve = 0.68). Rebleeding rates increased progressively with increasing scores (5.6%, 17.5%, 27.3%, and 100% for scores 0, 1, 2, and 3, respectively) and were significantly higher in the high-risk group (p < 0.01).

Conclusion

Rebleeding remained clinically relevant despite comprehensive gastrointestinal evaluation. The proposed risk score provides a simple and practical tool for identifying patients at increased risk of rebleeding and may support risk-adapted follow-up after a negative comprehensive gastrointestinal evaluation. Trial Registration: N/A.