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.