Download PDF
Clin Colon Rectal Surg 2020; 33(01): 016-021
DOI: 10.1055/s-0039-1695032
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Bleeding from Small Intestine: No Man's Land

Ara Sahakian
1   Department of Medicine, Keck Medicine of University of Southern California, Los Angeles, California
,
Sang W. Lee
2   Division of Colorectal Surgery, Department of Surgery, Keck Medicine of USC, Los Angeles, California
,
Joongho Shin
2   Division of Colorectal Surgery, Department of Surgery, Keck Medicine of USC, Los Angeles, California
› Author Affiliations
Further Information

Publication History

Publication Date:
07 January 2020 (online)

    Permissions and Reprints

Abstract

Bleedings from small intestine account for 5% of all gastrointestinal bleeding. With advanced endoscopic tools, such as video capsule endoscopy and deep enteroscopy, accurate diagnosis and treatment is possible in majority of cases with low mortality and morbidity. Nonoperative management includes endoscopic hemostasis and angiographic embolization. Recurrence after initial treatment is relatively common. Surgery is reserved for the cases that are refractory to endoscopic or angiographic treatment, bleeding from tumor or mass lesions, or hemodynamic instability. At the time of surgical exploration, unless the lesion has been marked by endoscopic tattoo or clip, intraoperative enteroscopy is often necessary to localize the lesion.

Keywords

video capsule endoscopy (VCE) - deep enteroscopy - intraoperative enteroscopy
 

  • References

  • 1 Rockey DC. Occult gastrointestinal bleeding. N Engl J Med 1999; 341 (01) 38-46
    CrossrefPubMedGoogle Scholar
  • 2 Ohmori T, Konishi H, Nakamura S, Shiratori K. Abnormalities of the small intestine detected by capsule endoscopy in hemodialysis patients. Intern Med 2012; 51 (12) 1455-1460
    CrossrefPubMedGoogle Scholar
  • 3 Samaha E, Rahmi G, Landi B. , et al. Long-term outcome of patients treated with double balloon enteroscopy for small bowel vascular lesions. Am J Gastroenterol 2012; 107 (02) 240-246
    CrossrefPubMedGoogle Scholar
  • 4 Rahmi G, Samaha E, Vahedi K. , et al. Long-term follow-up of patients undergoing capsule and double-balloon enteroscopy for identification and treatment of small-bowel vascular lesions: a prospective, multicenter study. Endoscopy 2014; 46 (07) 591-597
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Choi H, Choi KY, Eun CS. , et al; Korean Association for the Study of Intestinal Diseases. Korean experience with double balloon endoscopy: Korean Association for the Study of Intestinal Diseases multi-center study. Gastrointest Endosc 2007; 66 (3, Suppl.): S22-S25
    CrossrefPubMedGoogle Scholar
  • 6 Neumann H, Fry LC, Nägel A, Neurath MF. Wireless capsule endoscopy of the small intestine: a review with future directions. Curr Opin Gastroenterol 2014; 30 (05) 463-471
    CrossrefPubMedGoogle Scholar
  • 7 Gerson LB, Fidler JL, Cave DR, Leighton JA. ACG clinical guideline: diagnosis and management of small bowel bleeding. Am J Gastroenterol 2015; 110 (09) 1265-1287 , quiz 1288
    CrossrefPubMedGoogle Scholar
  • 8 Rokkas T, Papaxoinis K, Triantafyllou K, Pistiolas D, Ladas SD. Does purgative preparation influence the diagnostic yield of small bowel video capsule endoscopy?: A meta-analysis. Am J Gastroenterol 2009; 104 (01) 219-227
    CrossrefPubMedGoogle Scholar
  • 9 Carey EJ, Leighton JA, Heigh RI. , et al. A single-center experience of 260 consecutive patients undergoing capsule endoscopy for obscure gastrointestinal bleeding. Am J Gastroenterol 2007; 102 (01) 89-95
    CrossrefPubMedGoogle Scholar
  • 10 Albert JG, Schülbe R, Hahn L. , et al. Impact of capsule endoscopy on outcome in mid-intestinal bleeding: a multicentre cohort study in 285 patients. Eur J Gastroenterol Hepatol 2008; 20 (10) 971-977
    CrossrefPubMedGoogle Scholar
  • 11 Delvaux M, Fassler I, Gay G. Clinical usefulness of the endoscopic video capsule as the initial intestinal investigation in patients with obscure digestive bleeding: validation of a diagnostic strategy based on the patient outcome after 12 months. Endoscopy 2004; 36 (12) 1067-1073
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Triester SL, Leighton JA, Leontiadis GI. , et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 2005; 100 (11) 2407-2418
    CrossrefPubMedGoogle Scholar
  • 13 Saperas E, Dot J, Videla S. , et al. Capsule endoscopy versus computed tomographic or standard angiography for the diagnosis of obscure gastrointestinal bleeding. Am J Gastroenterol 2007; 102 (04) 731-737
    CrossrefPubMedGoogle Scholar
  • 14 Chen X, Ran ZH, Tong JL. A meta-analysis of the yield of capsule endoscopy compared to double-balloon enteroscopy in patients with small bowel diseases. World J Gastroenterol 2007; 13 (32) 4372-4378
    CrossrefPubMedGoogle Scholar
  • 15 Pasha SF, Leighton JA, Das A. , et al. Double-balloon enteroscopy and capsule endoscopy have comparable diagnostic yield in small-bowel disease: a meta-analysis. Clin Gastroenterol Hepatol 2008; 6 (06) 671-676
    CrossrefPubMedGoogle Scholar
  • 16 Teshima CW, Kuipers EJ, van Zanten SV, Mensink PB. Double balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding: an updated meta-analysis. J Gastroenterol Hepatol 2011; 26 (05) 796-801
    CrossrefPubMedGoogle Scholar
  • 17 Chak A, Koehler MK, Sundaram SN, Cooper GS, Canto MI, Sivak Jr MV. Diagnostic and therapeutic impact of push enteroscopy: analysis of factors associated with positive findings. Gastrointest Endosc 1998; 47 (01) 18-22
    CrossrefPubMedGoogle Scholar
  • 18 Plotkin E, Imaeda A. Small intestinal angioectasias are not randomly distributed in the small bowel and most may be reached by push enteroscopy. J Clin Gastroenterol 2016; 50 (07) 561-565
    CrossrefPubMedGoogle Scholar
  • 19 Yamamoto H, Sekine Y, Sato Y. , et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 2001; 53 (02) 216-220
    CrossrefPubMedGoogle Scholar
  • 20 Chauhan SS, Manfredi MA, Abu Dayyeh BK. , et al; ASGE Technology Committee. Enteroscopy. Gastrointest Endosc 2015; 82 (06) 975-990
    CrossrefPubMedGoogle Scholar
  • 21 Ohmiya N, Yano T, Yamamoto H. , et al. Diagnosis and treatment of obscure GI bleeding at double balloon endoscopy. Gastrointest Endosc 2007; 66 (3, Suppl.): S72-S77
    CrossrefPubMedGoogle Scholar
  • 22 Shinozaki S, Yamamoto H, Yano T. , et al. Long-term outcome of patients with obscure gastrointestinal bleeding investigated by double-balloon endoscopy. Clin Gastroenterol Hepatol 2010; 8 (02) 151-158
    CrossrefPubMedGoogle Scholar
  • 23 Möschler O, May A, Müller MK, Ell C. ; German DBE Study Group. Complications in and performance of double-balloon enteroscopy (DBE): results from a large prospective DBE database in Germany. Endoscopy 2011; 43 (06) 484-489
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Xin L, Liao Z, Jiang YP, Li ZS. Indications, detectability, positive findings, total enteroscopy, and complications of diagnostic double-balloon endoscopy: a systematic review of data over the first decade of use. Gastrointest Endosc 2011; 74 (03) 563-570
    CrossrefPubMedGoogle Scholar
  • 25 Takano N, Yamada A, Watabe H. , et al. Single-balloon versus double-balloon endoscopy for achieving total enteroscopy: a randomized, controlled trial. Gastrointest Endosc 2011; 73 (04) 734-739
    CrossrefPubMedGoogle Scholar
  • 26 Upchurch BR, Sanaka MR, Lopez AR, Vargo JJ. The clinical utility of single-balloon enteroscopy: a single-center experience of 172 procedures. Gastrointest Endosc 2010; 71 (07) 1218-1223
    CrossrefPubMedGoogle Scholar
  • 27 Domagk D, Mensink P, Aktas H. , et al. Single- vs. double-balloon enteroscopy in small-bowel diagnostics: a randomized multicenter trial. Endoscopy 2011; 43 (06) 472-476
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Rahmi G, Samaha E, Vahedi K. , et al. Multicenter comparison of double-balloon enteroscopy and spiral enteroscopy. J Gastroenterol Hepatol 2013; 28 (06) 992-998
    CrossrefPubMedGoogle Scholar
  • 29 Frieling T, Heise J, Sassenrath W, Hülsdonk A, Kreysel C. Prospective comparison between double-balloon enteroscopy and spiral enteroscopy. Endoscopy 2010; 42 (11) 885-888
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Buscaglia JM, Richards R, Wilkinson MN. , et al. Diagnostic yield of spiral enteroscopy when performed for the evaluation of abnormal capsule endoscopy findings. J Clin Gastroenterol 2011; 45 (04) 342-346
    CrossrefPubMedGoogle Scholar
  • 31 Messer I, May A, Manner H, Ell C. Prospective, randomized, single-center trial comparing double-balloon enteroscopy and spiral enteroscopy in patients with suspected small-bowel disorders. Gastrointest Endosc 2013; 77 (02) 241-249
    CrossrefPubMedGoogle Scholar
  • 32 May A, Manner H, Aschmoneit I, Ell C. Prospective, cross-over, single-center trial comparing oral double-balloon enteroscopy and oral spiral enteroscopy in patients with suspected small-bowel vascular malformations. Endoscopy 2011; 43 (06) 477-483
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Khashab MA, Lennon AM, Dunbar KB. , et al. A comparative evaluation of single-balloon enteroscopy and spiral enteroscopy for patients with mid-gut disorders. Gastrointest Endosc 2010; 72 (04) 766-772
    CrossrefPubMedGoogle Scholar
  • 34 Williamson JB, Judah JR, Gaidos JK. , et al. Prospective evaluation of the long-term outcomes after deep small-bowel spiral enteroscopy in patients with obscure GI bleeding. Gastrointest Endosc 2012; 76 (04) 771-778
    CrossrefPubMedGoogle Scholar
  • 35 Frydman J, Bahouth H, Leiderman M, Ofer A, Kluger Y. Methylene Blue injection via superior mesenteric artery microcatheter for focused enterectomy in the treatment of a bleeding small intestinal arteriovenous malformation. World J Emerg Surg 2014; 9 (01) 17
    CrossrefPubMedGoogle Scholar
  • 36 Bonnet S, Douard R, Malamut G, Cellier C, Wind P. Intraoperative enteroscopy in the management of obscure gastrointestinal bleeding. Dig Liver Dis 2013; 45 (04) 277-284
    CrossrefPubMedGoogle Scholar