TOPLINE:

Among patients with suspected small-bowel bleeding, those with P1 lesions identified using a modified Saurin classification had an increased risk for rebleeding. Additional independent predictors of rebleeding included the use of antiplatelet drugs and undergoing endoscopic treatment.

METHODOLOGY:

• Obscure small-bowel bleeding is difficult to diagnose and often recurrent; however, the Saurin classification used to stratify bleeding risk has not been standardized for endoscopic findings.
• Researchers conducted a retrospective observational study to assess whether a modified Saurin classification applied to balloon-assisted endoscopy findings could predict the risk for rebleeding.
• Patients with suspected small-bowel bleeding who underwent capsule endoscopy or balloon-assisted endoscopy between October 2008 and December 2023 at a Japanese center were included.
• Using the modified Saurin classification, lesions were categorized as P0 (low risk), P1 (uncertain risk), P2 (high risk), or no findings. Treatments were classified as endoscopic or definitive (surgical or interventional radiology).
• The primary outcome was the association between modified Saurin classification and rebleeding risk, with a median follow-up duration of 0.97 years.

TAKEAWAY:

• Of the 278 patients evaluated (mean age, 67.7 years; 54.0% male), rebleeding occurred in 32 (11.5%), with the highest rate observed in those with modified Saurin P1 lesions (19.3%).
• Independent predictors of rebleeding included modified Saurin P1 lesions (adjusted odds ratio [aOR], 2.49; P = .04), use of antiplatelet drugs (aOR, 3.02; P = .04), and endoscopic treatment (aOR, 4.56; P < .01).
• When stratified by the modified classification system, patients with Saurin P1 lesions had significantly higher cumulative rebleeding rates than those with P0 (P = .02) or P2 (P = .04) lesions.
• Patients who underwent endoscopic treatment had higher cumulative rebleeding rates than those who did not (P < .01).

IN PRACTICE:

“Our findings further support the predictive value of P1 lesions for rebleeding based on endoscopic findings assessed by modified [Saurin classification] and not limited to [small-bowel capsule endoscopy] alone. In other words, even minor findings may be associated with the risk of rebleeding in patients with [suspected small-bowel bleeding],” the authors wrote.

SOURCE:

This study was led by Sachiyo Onishi, Gifu University School of Medicine Graduate School of Medicine, Gifu City, Japan. It was published online on January 4, 2026, in Digestive Diseases and Sciences.

LIMITATIONS:

The retrospective, single-center design limited generalizability. Treatment decisions were made on case-by-case basis, introducing potential selection bias. Variability in timing and performance of endoscopic procedures may also have affected the diagnostic results.

DISCLOSURES:

This study received no specific funding. The authors reported having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.