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.