Enteroscopy in patients with gastrointestinal bleeding of obscure origin.
Approximately 5% of all patients with gastrointestinal hemorrhage will not have a bleeding site found after standard evaluation with upper endoscopy and colonoscopy. The source of bleeding in these patients is often the small intestine. In the past 2 decades, our ability to examine the small bowel endoscopically has been enhanced by the use of intraoperative enteroscopy and the development of push and sonde enteroscopes. In a stepwise evaluation of the patient with obscure gastrointestinal bleeding using enteroscopy, the identification of a bleeding source has been reported in 70-100% of patients, usually leading to palliative, if not definitive, therapy. In this review we discuss the indications, methods and yields of each of these procedures, and propose a diagnostic algorithm with which to approach these patients.
Adrain
A L
AL
Section of Gastroenterology, Temple University Hospital, Philadelphia, Pa 19041, USA.
Krevsky
B
B
D000465:Algorithms; D016888:Angiodysplasia / Q000150:complications / Q000175:diagnosis*; D020685:Colonoscopes; D003113:Colonoscopy / Q000379:methods; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D006801:Humans