Small bowel bleeding: cause and the role of endoscopy and medical therapy. Issue 3 (May 2018)

• Record Type: Journal Article
• Authors: Chetcuti Zammit, Stefania; Sidhu, Reena
• Is Part Of: Current opinion in gastroenterology. Volume 34:Issue 3(2018:May)
• Publication Date: 2018-05
• Subjects: dieulafoy lesion -- double balloon enteroscopy -- small bowel angioectasias -- small bowel bleeding -- small bowel capsule endoscopy -- small bowel diverticulosis -- small bowel tumour -- small bowel ulcers -- small bowel varices -- somatostatin analogues; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1097/MOG.0000000000000429
• Languages: English
• ISSNs: 0267-1379

Abstract

Abstract : Purpose of review: The objective is to provide an overview on the cause of small bowel bleeding. We discuss the role of small bowel endoscopy in the management of small bowel bleeding and provide an outline of pharmacotherapy that can be additionally beneficial. Recent findings: Small bowel capsule endoscopy (SBCE) is the initial diagnostic investigation of choice in small bowel bleeding. Computed tomography (CT) can be helpful in the context of small bowel tumours. Device-assisted enteroscopy (DAE) enables several therapeutic procedures such as argon plasma coagulation (APC) and haemoclip application. It can also guide further management with histology or by marking culprit lesions with India ink. A persistent rate of rebleeding despite APC is increasingly being reported. Pharmacotherapy has an emerging role in the management of small bowel bleeding. Somatostatin analogues are a well tolerated class of drugs that can play an additional role in the management of refractory bleeding secondary to small bowel angioectasias. Summary: SBCE is useful in determining the cause of small bowel bleeding. DAE offers an endoscopic therapeutic approach to small bowel bleeding replacing surgery and intraoperative enteroscopy. Pharmacotherapy, in addition to endotherapy, can play an important role in the management of multifocal, recurring bleeding small bowel lesions.