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Bleeding Lesion of the Small Bowel: an Extensive Update Leaving No Stone Unturned

Cedric Van de Bruaene1, Pieter Hindryckx2, Laurens Van de Bruaene3

  • 1Department of Gastroenterology, Ghent University Hospital, De Pintelaan 185, 1K12, 9000, Ghent, Belgium. Cedric.VandeBruaene@UGent.be.

Current Gastroenterology Reports
|March 9, 2018
PubMed

Insights

Small bowel bleeding diagnosis and management remain challenging. Capsule endoscopy and device-assisted enteroscopy are key, but long-term rebleeding rates are high, especially for vascular lesions like angioectasia.

Area of Science:

  • Gastroenterology
  • Endoscopy
  • Small Bowel Diseases

Background:

  • Small bowel bleeding (SB) presents diagnostic and therapeutic challenges for gastroenterologists.
  • Effective management strategies are crucial for improving patient outcomes.

Purpose of the Study:

  • To review current evidence on small bowel bleeding.
  • To provide a clinical guide and flowchart for managing SB bleeding, focusing on vascular and ulcerative lesions.

Main Methods:

  • Review of current state-of-the-art evidence.
  • Focus on diagnostic modalities like capsule endoscopy (CE) and device-assisted enteroscopy (DAE).
  • Evaluation of endoscopic management of specific lesions, particularly angioectasias.

Main Results:

  • Absence of lesions on CE does not guarantee a better long-term prognosis due to high rebleeding rates.
  • Push enteroscopy may be beneficial early if proximal angioectasias are suspected.
  • Endoscopic management of angioectasias yields suboptimal results.

Conclusions:

  • Capsule endoscopy and device-assisted enteroscopy are the primary diagnostic tools for SB bleeding.
  • Treatment decisions should be individualized based on patient factors and suspected lesion types.
  • Long-term rebleeding remains a concern, necessitating ongoing research into effective management.
Abstract

Keywords:
Capsule endoscopyEndoscopic treatmentGastrointestinal bleedingMidgut bleedingSmall bowelSmall bowel imaging

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