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"Missed" upper gastrointestinal tract lesions may explain "occult" bleeding
C Descamps1, A Schmit, A Van Gossum
1Dept. of Hepatogastroenterology and Pancreatology, Erasmus Hospital, Free University of Brussels, Belgium.
Endoscopy
|September 24, 1999
Summary
Push enteroscopy effectively diagnoses obscure gastrointestinal bleeding, identifying arteriovenous malformations (AVMs) and missed upper gastrointestinal lesions. This method is crucial for patients with persistent bleeding despite prior upper endoscopy.
Area of Science:
- Gastroenterology
- Diagnostic Endoscopy
- Gastrointestinal Bleeding
Background:
- Obscure gastrointestinal bleeding (GIB) poses diagnostic challenges.
- Arteriovenous malformations (AVMs) are common findings in enteroscopy for GIB.
- Upper gastrointestinal (GI) lesions can be missed by standard esophagogastroduodenoscopy.
Purpose of the Study:
- To investigate "missed" upper GI lesions in patients undergoing enteroscopy for GIB.
- To evaluate the diagnostic yield of push enteroscopy in identifying these lesions.
Main Methods:
- Retrospective review of 233 enteroscopic examinations (1993-1997).
- All patients had prior esophagogastroduodenoscopy.
- Push enteroscope (Olympus XSIF-100) was utilized.
Main Results:
- Push enteroscopy identified a bleeding lesion in 53% of patients.
- AVMs accounted for 63% of detected lesions.
- 10.2% of patients had missed upper GI lesions, often in the gastric fundus; Wirsungorrhagia was noted in two cases.
Conclusions:
- Push enteroscopy is effective for diagnosing obscure GIB, with a 53% diagnostic yield.
- A significant proportion of patients (10.2%) had upper GI lesions missed by initial esophagogastroduodenoscopy.
- Wirsungorrhagia should be considered in GIB evaluations, especially when lesions are in the gastric fundus.