What does this research mean for the field?

The novel COPPE score, which integrates capsule endoscopy findings and clinical factors, effectively stratifies rebleeding risk in patients with suspected small-bowel bleeding and demonstrates superior predictive performance compared to the existing RHEMITT score. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to create a prediction score that estimates the risk of rebleeding in patients with suspected small-bowel bleeding after capsule endoscopy.

June 23, 2026European journal of medical research0 citationsOpen Access

A novel prediction score for rebleeding in suspected small-bowel bleeding post-capsule endoscopy examination: a multicenter, retrospective cohort study

XTXiajiao TangZhongda Hospital Southeast University MLM M LiKing University CCCuie Cheng

Key Points

This research aims to create a prediction score that estimates the risk of rebleeding in patients with suspected small-bowel bleeding after capsule endoscopy.
Analyzed data from 321 patients with suspected small-bowel bleeding across four centers from October 2015 to April 2022.
Patients were randomly divided into training (229) and validation (92) sets at a 7:3 ratio.
Developed the COPPE score using LASSO-Cox regression based on capsule endoscopy findings and clinical factors.
During a mean follow-up of 25 months, rebleeding occurred in 22.7% of patients.
Five risk factors identified included positive CE findings, chronic liver disease, previous gastrointestinal bleeding history, overt bleeding duration > 3 months, and elevated serum urea.
The COPPE score demonstrated C-index values of 0.77 in the training set and 0.71 in the validation set, outperforming the RHEMITT score.

Abstract

Abstract Background The rebleeding rate in patients with suspected small-bowel bleeding (SSBB) ranges from 19% to 41.7%. However, the predictive factors and long-term risks of rebleeding across different clinical populations remain insufficiently clarified. To fill this gap, the present study aimed to develop the COPPE score integrating capsule endoscopy (CE) findings and clinical factors for assessing rebleeding risk in SSBB patients after CE examination. Methods A total of 321 patients with SSBB from four centers between October 2015 and April 2022 were retrospectively analyzed and randomly divided into a training set ( n = 229) and a validation set ( n = 92) at a 7:3 ratio. The COPPE score was constructed using LASSO-Cox regression. Its performance was evaluated and compared with the RHEMITT score, and a personalized follow-up strategy was explored. Results During a mean follow-up of 25.0 months, rebleeding occurred in 22.7% of patients. Five independent risk factors were ultimately identified: positive CE findings (3 points), chronic liver disease (3 points), previous gastrointestinal bleeding history (3 points), overt bleeding duration > 3 months (2 points), and elevated serum urea (2 points). The COPPE score, built on these five indicators, ranged from 0 to 13 points, with C‑index of 0.77 (95% CI 0.71–0.83) in the training set and 0.71 (95% CI 0.60–0.81) in the validation set. Time‑dependent AUCs for predicting rebleeding at 6–18 months were 0.73–0.78, which were significantly superior to those of the RHEMITT score (0.57–0.60, P < 0.05). Using 4 points as the optimal cut-off value, patients were stratified into a low‑risk group (0–4 points) and a high‑risk group (5–13 points). Based on the survival characteristics of the high‑risk group, a phased exploratory follow-up protocol was further proposed. Conclusions The COPPE score can effectively stratify rebleeding risk in Chinese SSBB patients. It helps clinicians distinguish high-risk patients for close monitoring and timely intervention, and formulate simplified follow-up plans for low-risk cases, so as to support individualized clinical management.

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