The Rate of Lesions Found within Reach of Esophagogastroduodenoscopy during Push Enteroscopy Depends on the Type of Obscure Gastrointestinal Bleeding

Lara, Luis F.; Bloomfeld, Richard S.; Pineau, Benoit C.

doi:10.1055/s-2004-825953

Cited by 33 publications

(19 citation statements)

References 17 publications

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“…Surgical intervention in massive small bowel bleeding may be useful, but is greatly aided with presurgical localization of the site of bleeding by marking the lesion with a tattoo (strong recommendation, low level of evidence). 29. Intraoperative enteroscopy should be available at the time of the surgical procedure to provide assistance to localize the source of bleeding and to perform endoscopic therapy (conditional recommendation, low level of evidence Age has been known to be a determinant for the type of small bowel pathology detected.…”

Section: Defi Nition Of Overt or Occult Small Bowel Bleedingmentioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Gerson

Fidler

Cave³

et al. 2015

American Journal of Gastroenterology

563

559

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Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended for patients with initial negative small bowel evaluations and ongoing overt or occult bleeding.

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Section: Defi Nition Of Overt or Occult Small Bowel Bleedingmentioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Gerson

Fidler

Cave³

et al. 2015

American Journal of Gastroenterology

563

559

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“…43,[49][50][51] In a study of 63 patients, after exclusion of all lesions proximal to the ligament of Treitz, the diagnostic yield for push enteroscopy was 41% in patients with recurrent overt small-bowel bleeding, 33% in those with persistent overt small-bowel bleeding, and 26% in those with occult small-bowel bleeding. 52 Push enteroscopy allows not only for diagnosis and biopsy but also for therapeutic interventions, such as hemostasis. Decreased transfusion requirements and improvement in functional status 1 year after treatment have been demonstrated after push enteroscopy.…”

Section: Role Of Second-look Endoscopymentioning

confidence: 99%

“…18,19 In patients with OGIB, upper and lower GI tract endoscopies often are repeated before small-bowel evaluation because substantial initial endoscopic miss rates have been reported. 20,21 Techniques for evaluation of the small bowel include VCE, DAE, multiphase CT enterography (CTE), magnetic resonance enterography (MRE), and, in rare instances, intraoperative enteroscopy. These modalities can recognize small-bowel lesions and may impact therapeutic strategies, often preventing surgical interventions.…”

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confidence: 99%

The role of endoscopy in the management of suspected small-bowel bleeding

Gurudu¹,

Bruining²,

Acosta³

et al. 2017

Gastrointestinal Endoscopy

129

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“…22,[31][32][33] In a study of 63 patients, after exclusion of all lesions proximal to the ligament of Treitz, the diagnostic yield for PE was 41% in patients with recurrent overt OGIB, 33% in those with persistent overt OGIB, and 26% in those with occult OGIB. 34 PE allows not only for diagnosis and biopsy but also for therapeutic interventions, such as hemostasis. Decreased transfusion requirements and improvement in functional status 1 year after treatment have been demonstrated after PE.…”

Section: Push Enteroscopymentioning

confidence: 99%