Long-Term Outcomes and Rebleeding Risk Factors in Suspected Small Bowel Bleeding: A Study Based on the Modified Saurin Classification

BACKGROUND: Small-bowel endoscopy is essential for diagnosing and managing suspected small bowel bleeding (SSBB); however, rebleeding after treatment remains clinically challenging. Although several rebleeding prediction models have been proposed, few are based on endoscopic findings, and data on long-term outcomes are limited. AIMS: This study aimed to evaluate rebleeding risk factors and long-term outcomes using the modified Saurin classification (modified SC), which is compatible with balloon-assisted endoscopy (BAE). METHODS: We retrospectively evaluated 278 consecutive patients with OGIB who underwent capsule endoscopy (CE) or BAE between October 2008 and December 2023. The lesions were categorized using modified SC as P0 (n = 58), P1 (n = 109), P2 (n = 71), or no findings (n = 40). Treatment was classified as endoscopic or definitive (surgical or interventional radiology). RESULTS: Of the 278 patients (mean age 67.7 years; 150 males), 158 had occult OGIB and 120 had overt OGIB. Treatment was administered to 73 patients (46 endoscopic and 27 definitive cases). Over a mean follow-up of 2.2 years, 32 patients (11.5%) experienced rebleeding. Multivariate analysis identified modified SC P1 lesions (odds ratios [ORs], 2.33; p = 0.03), antiplatelet drugs use (ORs 3.02, p = 0.04) and treatment interventions (ORs, 2.28; p = 0.02) as independent predictors. The 3-year rebleeding rate was higher in P1 (27.2%) than in P0 (9.5%) and P2 (13.8%). Rebleeding was more frequent in the endoscopic group (39.9%) than in the definitive group (10.5%; p = 0.04). CONCLUSION: Modified SC P1 lesions were significantly associated with rebleeding. Proactive treatment strategies and long-term follow-up are crucial for effective management of SSBB.