Role of Endoscopy in the Management of Suspected Small-Bowel Bleeding

Publication Date: January 1, 2017
Last Updated: March 14, 2022


For patients with signs or symptoms consistent with recurrent upper or lower GI sources of bleeding, we suggest repeating EGD and colonoscopy, respectively, before small-bowel evaluation. (⊕⊕oo)

We suggest VCE as the initial test for patients with overt or occult small-bowel bleeding. Positive VCE results should be followed with push enteroscopy if within reach or DAE. (⊕⊕oo)

We suggest DAE or push enteroscopy if VCE is unavailable or nondiagnostic in patients with overt small-bowel bleeding. (⊕⊕oo)

We suggest that in select circumstances (eg, high level of suspicion of small-bowel angiectasias or in patients with surgically altered anatomy) DAE may be considered as the initial small-bowel diagnostic procedure in patients with small-bowel bleeding. (⊕⊕oo)

We suggest that after an appropriate negative evaluation, clinically stable patients without recurrent bleeding may be treated with iron therapy and clinically followed if iron deficiency is present. (⊕⊕oo)

We suggest multiphase CTE or MRE in patients with obscure bleeding and suspected small-bowel neoplasms. (⊕⊕⊕o)

Following appropriate hemodynamic resuscitation, we recommend angiography for selective embolization in patients who present with hemodynamically unstable suspected small-bowel bleeding. (⊕⊕⊕o)

We suggest a CTA or RBC scan for localization of the bleeding site and to guide timing of angiography in hemodynamically stable patients with suspected active small-bowel bleeding. (⊕⊕oo)

Recommendation Grading




Role of Endoscopy in the Management of Suspected Small-Bowel Bleeding

Authoring Organization

Publication Month/Year

January 1, 2017

Last Updated Month/Year

June 5, 2023

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital, Outpatient

Intended Users

Laboratory technician, nurse, nurse practitioner, physician, physician assistant


Assessment and screening, Diagnosis, Management

Diseases/Conditions (MeSH)

D016099 - Endoscopy, Gastrointestinal, D041742 - Upper Gastrointestinal Tract


upper GI endoscopy, Overt small-bowel bleeding, Occult small-bowel bleeding, small-bowel bleeding

Source Citation

Gurudu, S. R., Bruining, D. H., Acosta, R. D., Eloubeidi, M. A., Faulx, A. L., Khashab, M. A., … DeWitt, J. M. (2017). The role of endoscopy in the management of suspected small-bowel bleeding. Gastrointestinal Endoscopy, 85(1), 22–31. doi:10.1016/j.gie.2016.06.013