The primary aim of this study was to evaluate the diagnostic yield of CE in patients with obscure small bowel bleeding. A secondary objective was to identify predictive factors for angiodysplasia in the two patient groups under investigation: those with occult bleeding and those with overt bleeding.

We conducted a single-center, retrospective observational study including all CE procedures performed at the Gastroenterology Unit of Azienda Ospedaliera–University of Padua between January 2018 and September 2025 for overt or occult gastrointestinal bleeding. Demographic, clinical, biochemical, and endoscopic data were prospectively recorded in a dedicated database. CE findings were classified according to the presence of angiodysplasias, ulcers, erosions, red spots, polyps, and evidence of bleeding. Furthermore, the Saurin classification was employed to evaluate the bleeding risk, according to each lesion’s potential for clinically significant hemorrhage. Patients were categorized into overt bleeding (melena or hematochezia) and occult bleeding (anemia or positive fecal occult blood test) groups. Univariate and multivariate analyses were performed to identify factors associated with angiodysplasia, ulcers, and red spots. Statistical analyses were conducted using STATA 18.

A total of 1,049 CE procedures were performed for suspected gastrointestinal bleeding, including 323 for overt and 726 for occult bleeding. The mean age of the patients was 71 ± 14 years, with a predominance over 60 years, and 54% were male, without significant differences between groups (p= 0.084). At least one comorbidity was present in 66% of the case. The overall diagnostic yield was 71% (75% for overt and 74% for occult bleeding). Angiodysplasia was the most common finding, with similar prevalence in both groups (53.2% vs. 56.0%, p = 0.398). In multivariate analysis, a hemoglobin drop of at least 2 g/dL and iron supplementation therapy were the only independent risk factors for angiodysplasia among patients undergoing CE for overt bleeding. In patients who underwent CE for anemia or occult blood, the probability of detecting angiodysplasia increased with age in multivariate analysis: 45–60 vs. <45 years OR 5.03 (95% CI: 1.37–18.46); 61–80 vs. <45 years, OR 7.22 (95% CI: 2.08–25.01); and >80 vs. <45 years, OR 10.59 (95% CI: 2.98–37.56).

Our study confirms the high diagnostic yield of capsule endoscopy in patients with both overt and occult gastrointestinal bleeding. Angiodysplasia emerged as the most frequently detected lesion and we identified advanced age, iron supplementation therapy, and a hemoglobin drop of at least 2 g/dL from baseline as independent risk factors for detecting these lesions.These findings underscore the importance of considering patient age and the degree of anemia when evaluating patients with obscure gastrointestinal bleeding and may help guide the prioritization of CE in clinical practice.