GASTROINTESTINAL ENDOSCOPY, VOLUME 58, NO. 5, 2003
For the following points: (A), prospective controlled trials; (B), observational studies; (C), expert opinion.
OGIB comprises approximately 5% of all patients with GI bleeding, with the majority of lesions located in the small intestine. (B) Common small intestine lesions include angiodysplasia, tumors, NSAID enteropathy, and Meckel’s diverticulum-associated ulcers. (B) Obscure GI bleeding can either be occult, manifesting
as IDA, or overt, manifesting as hematochezia or melena. (C) Once upper and lower GI lesions have been
excluded by carefully performed repeated EGD and colonoscopy to the terminal ileum, examination
of the small intestine is warranted. (C) Diagnostic tests include PE, CE, barium studies (SBFT or enteroclysis), nuclear medicine testing, angiography, and IOE. (B) While large published comparative trials are lacking, PE has been shown to be superior to EGD and SBFT, and CE is similarly superior to SBFT and possibly to PE as well. (A) Choice among tests has yet to be established and will be dictated by the clinical scenario, availability, and local expertise. (C) Intra-operative enteroscopy is reserved for patients with refractory severe recurrent bleeding, transfusion dependency, or those in whom a lesion is identified that cannot be treated by using PE or colonoscopy with ileoscopy. (C)
Once a diagnosis is established, appropriate medical and/or surgical therapy must be individualized. (C)
American Society For Gastrointestinal Endoscopy
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